SFD (9602-025)44835 Los Manos Dr
9602-025
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 #LicxClasS)) D e ) !
;Date I — Y Signatureof Contractor I/ .. X11_ t t i" , " • 9
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
WORKERS 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 c9 fjr t'hr& hhhV performance of the work for whiWth sl` lrmit 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 thgse pr Clitoris. 1
'Date: '2•- - 9 (o Applicant y
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'.ost of compensation, damages as provided for in Section 3706
of the Labor Cde, 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' ppurrpposes.
Signature (Owner/Agent)-GG.,I _- Date
ALC
BUILDING PERMIT PERMIT•
ts1.#A _AA fi
DATE 2/7/96
/7/9 VALUATION $128,391.961 LOT i 15
TRACT D913
(OWNER
41.865 BOARDWALK H212
PAL1Lq DES ,RT CA 92211
(6 19?777-776<,
USE OF PERMIT
)INGLE FAMILYDWELLING
QUIhPfEttRA '.
PI. AN 2
CONTRACTOR
R00 ER SIvrU.T.-NRAER.rER,, & ASSOC.
411865/ BO,i :f MIVA:. K A212
]RALM DESERT CA 92211
f31ARLES :f7. GARLAND
33- ,53? CA?'11Ei' RAL CANYON 1:1,R.
FEE DESCRIPTION I FEES
TRACT' CJO"NSTRUCRION 7.149.00 SF
GA12ACII?/C{ARPORT 597.40 SF
E;fia".IMAUD COST OF C:ONiSi`RUa,'T€ON
PERMIT VVE SUMMARY
fsi.tltvCHi3.Kt=t I?
101-00043 t:tR
867.5
CC)?v81'RiJUfIt?I FJE
101-000-418-000
$74.1.t10
ME7(`HANI.<:AL ME-
101 -ON -421-400
$53.
ELECTRICAL .'FEE
IOl-000-420.000
$135
Qi,Ul BINC; !ms's
101-000-41.9-00
5154.
S'I'ONC MOTION :17.EE - RESID
101-000-241-000
$1
C' RADINO r,Ee
1,01.000423-000
$20.
1NF'R"IT(UC TU1R6 FEE
225-000-143-3412
$.'1,,FS".
AN T IN POEILTC PLACES - RES11; 701-000-255-000
$70.
RECEIPT
:Bf.
Jil
66
0n
84
00
82
98
CONSTRL MION AND PLAN CHECK
LESS PRE -PAID FEES
AL PERMI`! FEES DUE NOSY
121,:9€.90
$4.692.41
$0.00
$4,692.41
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROV S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air .
Roof Deck
OFExhaust
Fans
O.K. to Wrap
i
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
I
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWAL
A PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
111o,
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
ft. y
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) qz�M_4 r-7100
ELECTRICA A PROVALS
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)
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14101
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 44835
City La Quinta
Street Los Manos Dr.
Tract # 23913 Lot # 115
Type of Development Single Family Residence
Comments
APN # 604-272-009
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Square Footage 2149
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 2,149 or $3,696.28
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.
y-
Fees Paid By Roger Snellenberger & Associates Telephone- 777''766
Name on the check
jY
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,696.28
Signature 1, X C d 1,1A P PQ . LAA / YA-
Check No. 11027
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