SFD (9602-033)44685 Los Manos Dr
9602-033
ALC N
LICENSED CONTRACTOR' DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with DATE
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 113 jos sm
,. f l
License # Lic. Class 4 E)(D OWNER
Date Signature of Contractor 7-110f` s.
1 hereby affirm that I am exempt frorh 9 Contractor's License Law for the
following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec, 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This sect9n ng"ite completed if the permit valuatigsi s fsrifs.l 00.00 or less).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation p visions-of'Secti n700 of the Labor
Code, I shall forthwith comply with tho r vl'sio. S.
Date: Applicant t
Warning: Failure to secure WorkerCompensation coverage is unlawful and shall
subject an employer to cnmin penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
.
any permit issued as a resuftofjth a9 l I n agrees to, & shall, indemnify
& hold harmless the City of Indian -Wel s, its d cers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
VALUATION 16.121,,634,11)l LOT
44.685 LOS AIANOS D)r iVE
41865'80X DVVY% ,k ft'212
P A L N4 1) E S I, Wf CA 9281.1
(fl14)777-7766 `
USE OF PERMITINGI E F.ANRL Y
QUINrUCKA
PLAN 1
-J'RAC` T CONS- Ctl)(;"J' ON
GABA 1CARPORT
TRACT
s
96412.4113.3
APN
604-'26-5-006
ROGER SNEL,L,L NBER.GER fit; ASSOC.
41965 BOARDWALK #212
PALM DES1 t2'T CA 92211
(619)777-77601 C13L # 1858
DESIGNERIENGINEER
CHARI -5 D. GARLAM
33-I63 CAT14.1i RAL CAM'OIdDR.
2,1)15.00 sI,
62600 SF
04TFWAlTED CaST I7F CONST.iiiJMON
121,694.10
PERMIT FEE SUMMARY
PJ, AN CKC91 Pfd,
101 -OW -439-3113
$597.06
--- -
CONST.RUCTf(--)N FFE
101-000-419-000
$716.50
Mi~C:HAN CAL FBI
1.01 -400421 -()()Ci
5.53.50
h-I:FCTRICAI„ FEE'
1101-000-420-000
11311.55
C7)PIMN313RNO
FEE
3 01 -t00 -419-0W
$134,00
STONG M071014 P - MSID
141-000-241-000
$112.17
]
01?1W- INO FFA
1.0'1 -WO -423-000
0.00
0
i
INF£cASTRUCTUREF'EE
2,2:5-000-443-342
52,737.89
Q W i
ART IN PUIMIC PL ACES - RESM 741 -OW -255-400
$54.21
LL -
SUB -TOTAL CONSTRUCTION AND PLAN CHECKI $4,476SR
LESS PRE PAII)1 EES $0.00
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purpbses.
Signature (Owner/Agent) fZX 1.153 _i" RECEIPT DATE
170'FA.I,'PERMIT FEES DI!1r: NONV 1 $4,476.88
FINALED ]INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Patty Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL PPROVALS
POOLS - SPAS
steel
Set'Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL5' J4 AP ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14111
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 44685 Street Los Manos Dr.
Jurisdiction
APN # 604-265-006
La Quinta
Permit #
Log #
City La Quinta Zip 92253 Study Area 233
Tract # 23913 . Lot # 110 Square Footage 2015
Type of Development Single Family Residence No. of Units 1
Comments
By
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 x 2,015 or $3,465.80
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Roger Snellenberger & Associates % 'felephone ;777-7 ,06
_ r
Name on the check
:I
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,465.80
Check No. 11027
Signature 20 a 0 J'ANA 10 At n A
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting