SFD (9602-026)44865 Los Manos Dr
9602-026
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. 488234 }3 41
License # Lic. Class A. Exp'Date
,Date Signatureof Contractor .
OWNER-BUILDER DEC RATION
I hereby affirm that I am exempt frg 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 sectio need; t.l a completed if the permit valuation 's forfI00.00 or less).
() I citify At nate performance of the work for whic nth s 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 xif I_should become
subject to the workers' compensation provisions of Section 37@ of the Labor
Code, I shall forthwith comply with Diose provision
ate: Applicant
Warning: Failure to secure Worke s' Co pensation coverage is unlI and shall
subject an employer to crimia nalties 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 IrKJian W0110i officers, agents and employees.
2. Any permit issued as a reZ 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 purpo s. _
rSignature (Owner/Agent) >! Date
t
A""
BUILDING
PERMIT
PERMITS
DATE V C4.96
VALUATION S121,"4,11H
LOT 116 TRACT 2.391-4
JOB SITE ADDRESS 44-865 LOS ibiA1NOS DRXVE
APN 604-272-008
OWNER
CONTRACTOR
ROGER SNFLUN13lii2G1rR & ASSOC.
ROGER SNLLLFI N:8EFGER & ASSOC
4:1€;65:BOA.1'..DWA ,K 9212
41865 .E30 .A:RDWALK 0212
('ALM DESERT CA 92211
PALIVI DES:1 tt' CA. 92211
(619)777-7766 C.BL# 1859
(6 19)777.7766
DESIGNER/ENGINEER
MARLES D. GARLAND
33-163 C:A.THIMRAL CAiMN DR.
USE OF PERMIT TNG E 1;AMLY DWELLING
rw •, T f-4'VV r (0134
QUIN'T'Y{ RA
PLAN i
FEE DESCRIPTION
FEES
mAar (:owrRUC110N 2,015.003f,
CAiWXYCARPORT 626,00 3.F
ES'nMA'TED COSI' OF CONSTRUCTION
123,694,10
f':ER1b[IT FEE SiJMMA'kY
PLAN CNBC K FFE 101.4100-r139-118 $597.06
CCNSMUC'TION FFE 101.000-118-000 $716,50
M11CWWWAL r -.U- 10.1-000-421-000 $53.517
ELEC'TWCAL 1,+:Ll 101-000-420-000 513151%
CO
PLUMT4(74. FF1; 101-0100-419-000 $I54.1►n
X0140NNIat Y:,'N FES - RE -SM -6 512.17
o :
CRANNO F'M 101-01011-423-000 S20.f 1
cp
IMilt ASTRUC'1..U. ...FEE 225-000-443-342 S2,737.89
0
ART 31`1 r'l BLIC; MACES-RESP17011-M0-2554),0) $.4.2 1
a` , W
LL -
L -SUBTOTAL
SUB -TOTAL CONSTRUC;iION ANIS PLAN CRECK
$4,476,88
LESS PRE -PAID FEES
$0.00
TOTAL PE1t 19111` FEES DUE NOW.
$4,4761,81
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APR VALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel 40
Combustion Air
Roof DeckExhaust
Fans •
0. 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
Drywall - Int. Lath
Final
Final
BLOCKWALL A P OVALS
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 APPI19NALS
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 Y4 Lf
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
Final
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/2/96
No. 14102
Owner Name Roger Snellenberger & Associates
No. 44865
City La Quinta
Street Los Manos Dr.
APN # 604-272-008
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 233
Tract # 23913 Lot # 116 Square Footage 2015
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 2,015 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' 17.0ephoae X77 7-776-
Name on the check
^x ; i
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,465.80
Check No. 11027
Signature ;(- L -4 b 4A Ptl i)(A 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