SFD (9606-113)LICENSED CONTRACTOR. DECLARATION
I hereby affirm under penalty of perjury that l'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.an.d effect.
License # Lich Class Exp. Date'
Date Signature of :Contractor _ •
OWNER=BUILDER DECLARATION
I hereby affirm under penalty of perjury 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. 704'4•�Business & Professionals
Code). .• 2,
O I am exempt under Section ' B&P.C. ,for this reason,
Date Signature• of Owner `
17--,t
WORKER'S COMPENSATION DECLARATION
I hereby affirm' under penalty of.perjury.onerof;the following ,declarations:
O I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for. by Section 3700 of the' Cabo_ � 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 certify that in the performance of the work for which this permit is='
I shall not employ any person in manner so as to become subject to the
workers' compensationlaws of•.California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of .the Labor
Code, I shall forthwithcomply with those provisions.
Date: Q_ 4;,. 0 Applicant i'�� F. "C•. P ", r�a^��.
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 applicaton agreesto, & shall,- indemnify
& hold harmless the City of La Quinta, 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""� -= \r, •l , • 1`� y Date 11 rf
BUILDING PERMIT
PERM T# , ,y ,; CONTRDLI7
9606-113 4038
DATE VALUATION' LOT
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TRACT
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ADDRESS
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR.
,,
n -
.
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.
FramingCompressor
Insulation W 7b
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
09
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 I
Gas Piping
PLUMBING APPR VALS
Gas Test
Electric Final
Waste Lines oe J2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out q
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral I
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APiPROVALS
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 Ph 4ak 1i
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/12/96 APN # 604-261-003
No. 14843 Jurisdiction La Quinta
Owner Name Roger Snellenberger
N0.44565 Street Milago Dr.
City La Quinta zip 92253
Tract # 23913-6
Type of Development
Comments
Lot # 42
Permit #
Log #.
Study Area 233
Square Footage 2149
Single Family Residence 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 1.84 x 2,149 or $3,954.16
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.
ky'
Fees Paid By Roger Snellenber er & Assoc., Inc. Tel ep`hone
777-77:66
Name on the check
By Dr. Carol McGrew 4 ;
Administrator in Charge
f,1 � ro, ,
Fee collected /exempted by Pauline Pearson Payment Received $3,954.16
Check No. 0013514
Signature s l m P(VA1AA2VV"--
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