SFD (9602-035)44745 Los Manos Dr
9602-035
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is In full force and effect.
License # Lie?'QlNS1 13 Exp. Date 12./30/97
, Q to Signature ofContractor i
40
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the 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 section need not be completed if the permit valuation is for $100.00 or less).
( ) I ccfMfytfi6t1ihT9i-0)performance of the work for whi6", , i6i 6rmit 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with Vse pr Islons.
-Date: 2 5'G, Applicant f l_I!/ .r b:
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal 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 result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, 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.
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 purposes.
Signature (Owner/Agent) ... Date 2—S"- f.
ALCM
BUILDING PERMIT
PERMITS
1,1Arti7_.Ad K
DATE2/ 7/96
VALUATION $15 ,9S9.R♦1 LOT i 12
TRACT 23913
JOB SITE ADDRESS
APN
AA -'7 i '4 'Wn Q II
QA 241Z AC< A
OWNER -
CONTRACTOR
ROGER SNE'LL NDERGER &A MC.
PLOCER SrlELLENBEIa.GER & ASSOC
4.1865 Bf9ARUWALK ;:2 i2
4186513OAiZDW LK.f#212
PALM DESERT CA 92211
PALM DESERT CA 922.11
1,41OA-T" =gi rra u f Act!
DESIGNER/EIJGINEER
(619)777-7766
C'H"LE"5' D. CiARLAND
33-163 CKWMRAL CANYGN LAR..
USE OF PERMIT
SNA GLL i'AMILY'DWELL1NG
CATHEDRAL CIW, CA 92234
C Ui i'1' .:R1tA
:FLAN 4
FEE DESCRIPTION
FEES
TRACT C OWSI'FtUC71 N 2,730.90 8F
GARACEtCx ORT 598,00 SP
ESTIMATED COST OF CONSTRUC'YTWN
1.a9,959*6
PERMIT FEE SUMMARY
Y
PLAN (WECK FE 1, 101.-000-419..318
CON'STWOCTIONI 101-000.413-000 $549.50
M1'tC:r ANIC;AL MM . 101.000-421.0(10 $0.00
1 LE(,"iR1CAI...F'iy.:1s 101-000-420-000 $156.01
1aUNBIN0° FEE 101'003-419-00f) $1,99.00
S'TC7NG tLIOT1 eNf`Et +RES1.D 1Q1-000-211-000 $16.00
CIRM)YNG blUrll 101-000-423.000 $20.00
1N-3tAS'4°l2UCTUR- L' I+X. 275-000-443-M2
AU 1N PLM -1,1C N.A(,TP ,. RES!1 '701-000-2 +5 -WO $149.90
O
UB- CONS`rRUCTION AND PLAN CHECK
$5,749"41
FF LESS PRE-PAWTES
B
$0.00
8 1996 '1r9FkL PERMIT FEES DUE NOW/
4y
$5,749AI
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A A
Underground Ducts
Forms & Footings A
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
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -19
Drywall - Int. Lath
Final
Final-
BLOCKWALL AP ROVALS
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 AP O ALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping fPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection C7Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 76
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage 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
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
No. 14113 Jurisdiction
Owner Name Roger Snellenberger & Associates
No. 44745 Street Los Manos Dr.
City La Quinta zip 92253
APN # 604-265-004
La Quinta
Permit #
Log #
Study Area 233
Tract # 23913 Lot # 112 Square Footage 2730
Type of Development Single Family Residence No. of Units 1
Comments
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 2,730 or $ 4,695.60
the property listed above and that building permits and/or Certificates of Occupancy for
k•_
this square footage in this proposed project may now be issued.
Fees Paid By Roger Snellenberger & Associates
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
Telephone 7.77-7766
Check No. 11027
Signature P .iA E.v. c l At , Q/✓
$4,695.60
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