14544 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
Address 48`625 Pasco arazo LA QUINTA, CALIFORNIA.92253
Owner
11 1
Roger Snellerbergelr & Misociates
Address 41--863 Boardwalk #212
City Zip Tel.
.Palm Desert, C 92211. 11619)777-7766
Contractor
Same
Address
City- lZio Tel.:
State Lic City
& Classif. B -.488.234 Lic.,# 1858
Arch., Engr:,
Designer C8r'16s-- Elias - Engineer "
M23 Charleawarth Dr. 41TC.19) 328-7271
&Itythedral-City 9' CA 92234 Lict#
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I am licensed under provisi ns of'Chapter 9 (commencing with Section
7000) of Diivision 3 o/}the Busiinte6s and, rofessi n Code, aKdd my license is in full fprce ands,
effect. 7ct�e :•�tt^'t�7 P.:Sr'� � r��i-,�G-c3'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and.Professions Code: Any city or county -which requires a
permit to construct, after, improve, demolish, of repair any structure, prior to its issuance also -
requires the applicant for such permit to- rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is ,exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). - -
❑ 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,. Buisness and
Professions Code: The Contractor's License Law'does not apply to an owner of property who
builds or improves thereon and who does- such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion; the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) -
• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License taw
does not apply to an, owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to.the Contractor's License Law.) -
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION.
I hereby affirm that I have a certificate of consent to self insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol�icyy Company
�H"Copy is filed with the.city, . O. Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE-
(This section need not be completed If the permit is for.one hundred dollars ($100) valuation
' or less.) -
I certify that in the performance of the work for which this permit is issued, I shall not
employ
anyperson in any manner so as to become subject to the Workers' Compensation .
Laws of California
Date Owner
No. 14544.
t
11LDING: TYPE CONST. Vl' OCC: GRP.
P. Number 646-082-013
Lot 39 `i'ract 2€3052-4
:gal Description _
oject Description SFD i�i8�
Laguna De La Paz
Sq. Ft. 1Sto No.
Size Stories
No. Dw.
Units
New ❑ Add El.'- Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const..
Mech.
Electrical "
Plumbing
S.M.I.
'Grading
Driveway Enc.
Infrastructure
€+. In Pl 1
TOTAL
REMARKS.'
61071
aces
.00
AMOUNT
137.04
150.00
20.00
.00
G, 369..3
. ou
t -
.U14.34
NOTICE TO APPLICANT: lt, after making this Certificate of Exemption you should become
. subject to the Workers' Compensation provisions of - the Labor Code, you must forthwith
.ZONE:
BY:
comply with such provisions or this permit shall be deemed revoked
Minimum Setback
Distances: -
Front Setback from Center Line
Rear Setback from. Rear Prop., Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND .
Side Street$etbackf omCenterLine
SHALL SUBJECT AN EMPLOYER TO -CRIMINAL PENALTIES. AND CIVIL FINES UP TO ONE
//`� / `
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION_
Side Setback froPropel y>Line
'.
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
• •
FINAL DATE
+�•,
:• INS ECTOR, R
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
w
/Date q�li,
I certify that I have read this application and state that the above information is correct.
Issued b y'
Permit6/�
I agree to comply with all city and county ordinances and state laws relating to building
{ construction, and hereby authorize representatives -of this city to enter the above-.\
V
mentioned property for Inspection purposes.
,O
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT. ®
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
m POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
-$
SQ.FT.GAR ® 3/.c
HOUSE SEWER
FRAMING 3 )
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING - LECTRICAL HEATING & AIR COND. SOLAR
-- TTiaF�iY
SETBACK
GROUND PLUMBING Z4 5
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE IV
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS,-
SEWER O AROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
I
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING 3 )
FINAL INSP.
ROOFING
0 f
3
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING u N
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL