SFD (9602-023)44775 Los Manos Dr
9602-023
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. 4.8234 .B 0/ f
License # Lic. Class A Exp: Date ,/ a
Date Signatureof Contractor
OWNER -BUILDER -DECLARATION
I hereby affirm that I am exempt frm #16 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 cArtificate of consent to self -insure for workers'
compensation, as providedifor by Section 3700 of the Labor Code, for the
performance of the work for whichdthis permit is issued.
( ) 1 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 sect op gedf l completed if the permit valuatiRp's foSy$ 00.00 or less).
() I certify at In the performance of the work for whic 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 provisions .,of Sd&ion.3700 of the Labor
Code, I shall forthwith comply with those,pr ions
Date: Applicant
Warning: Failure to secure Worke Compensation coverage is unlawful and shall
subject an employer to c irrai al 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 bf th is.'apQlicatio n agrees to, & shall, indemnify
& hold harmless the City of In iiap kV its offiiCers, 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.
DATE Zf OPJO I VALUATION 5,11 Z9 s634.11)i LOT
TRACT
JOB SITE ADDRESS APN
44-77.5 LOS IMAANOS DIU VE I 604-27-2-4A A
ROGER tii+PF'C:LEN'.}3 ''GER & ASSOC
41.865 BOA.RDW.ALK i21l
PAi.M UE SE R.T CA 92211
(6:!.9)777-7766
USE OF PERMI13,ING ,E 1'AMILY
QUIN-171UtA
PLAN t ,
't'CdACS''T C0N,1VYR;UCr10N
GA1 AGNCARi ORT
iSOCYF1t, SNE LL F N13 -CR (3,ER & fSSsKX.
41865180ARDWALK. #212
PALM DESEWf CA 92211
(619j777-7766 CBLO 1958
DESIGNERIENGINEER
CHARLES D. GAIMAND
33-163 CA?`WDRAL CANT +, N DR
2,015.40 .±F
626.00 ;iF
ES'1rIMA'i'.IED COST OF CONS'T'RUCTION 1 121,684.10
D'.iiaietilUTiIrF 'l+".sESS a I }E IARY
PLAN
101-000-439-318
CJNS'(R UCTI(.5N FM
101 x000-`113-000
MECHANICAL 1-1-B
101-000-421-M
ELE(.CI'MCAL FFX1
101-000-420-000
P1;t11 4,aPs 3vl lc`.Y,gFE1^r . t
1101-p( ?( D-41`9-/0 t 10
qy
w RID
e5'1 NG 10,10 l ON, iai'M - til;..SID
101-tk)f3-2 <4.l"' 0
c3XLAtattVti t"13t?
101.000-423-000
(NF IRAS RUC'1`LIRE .F Ts
225-000-443-342
ART 1N PLi.BLIC KAMs - "ttysrr,
701-040-255-000
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 RECEIPT
$597.06
$716.'50
$53.51
rn
$131.55
vs
$154;110 "
co
$;,2.11
0
V20,00
a m
LLJ
52,737.89
LL-
i554.2E
S54111
D
SUB -TOTAL COl+1S"CRUC-"i ON AND PLAN CHECK
LESS PRE-P.A D FEES
DA
TYTAL PERMIT FEM DUE NOW
TE RNALED [INSPECTOR
$4,476.88
$0.00
$4,416.88
INSPECTION RECORD ,r -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Jo
Ducts
Slab Grade
Return Air
Steel gglogCombustion
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL AFROVALS
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)
ELECTRICAL APPROVALS
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
17,
Final
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14099
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 44775 Street Los Manos Dr.
City La Quinta
Tract # 23912 Lot # 113
Type of Development Single Family Residence
Comments
APN # 604-272-011
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Square Footage 2015
No. of Units 1
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.
J,, t'
Fees Paid By Roger Snellenberger & Associates <: Te1e ione 777-7766
Name on the check
By Dolores A. Ballesteros
Superintendent ;e
Fee collected /exempted by Pauline Pearson Payment Received $3,465.80
Check No. 11027
Signature
&_ 't/
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