9604-059 (SFD)<•s b ' • .. ... _- ti. - J.• i�—.. ._��.-tee_ �—. ,
LI CENSED`CONTRACTOR,DECLARATION
>'I hereby affirm under penalty of pequry''that I am licensed under provisions of
Chapter 9 (commencing.with Section, 7000) of Division 3 of +he BusiAess and
Professionals Code and my License is in full force.and effect`, a
License # Lic. Class Exp. Date �.
482
'll�� �0/97
Date/j'' ' y` Signature of Contractor �•.� I Via• °�—
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 myemployees 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)..
(•) 1, as.owner'of.•the, property,•am exclusively contracting with licensed
contractors to construct the project.(Sec. 7044,rBusiness & Professionals
Code).. 4 -, '. • . ,.
O 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, fgr.the
pertormance of the work for which this permit is issued. . . • '
( j J 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:
Policy No.
Carrier a`('A.,3 L ru, 62635395
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 certify thatin the performance of the work for which 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.l should become
subject to the workers, compensation provisions,of Section.3700 of the Labor
Codeh'I shall forthwith comply with t�hose provisions..
Date'`1�1�_ Applicant A + ( A/.?I -:Fi i �,R A �(
FP •
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 agrees to, & 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)}' i t V AG• Date 4, it:Vdl
;/
. YV'�DII\M PERMIT'
-.. `.'" -. •
PERMITS CONTROL#-
3155'
DATE. VALUATION "' LOT
411706';4.5t�,!�9.430
96044)59
TRACT
►13 P:f.S
JOB SITE A
ADDRESS. :W4575 W.&A C:°IRC:@' IL
APN
�►t�{+�- � -fli�
OWNER(
CONTRACTORDESIGNER ENGINEER
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USE OF PERMIT
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3?1h;1tN0 cr Poll -1-11 SUt`'!�NIARY
MAN C'3`if; r -K (TF., 19,
" : $708.0
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CONNX ICT N !•.E b_' 11-091-000-418-000
$849.50
NIMIKNICAL VDI i01-000-421-000.
860.00
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$0400
' '�'a41 I .1%.t�`M� f+1,1�� 339+1 NOW
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
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
OX to Wrap
F.A.U.
Framing XC2-
Compressor
InsulationVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
'Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
e BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APP OV LS
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 WrE
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: w
Final
lee
UtilityNotice (Gas) 4 411 UK'.
ELECTRICAL PP OVALS
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
Al
Final,
Utility Notice (Perm)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/17/96' " APN # • 604-262-006
No. 14335 Jurisdiction La Quinta
Owner Name -Roger Snellenberger & Associates, Inc. Permit #
No. 44575 • Street Pala Cir. Log #
City La Quinta Zip 92253 Study Area 228
Tract #. 23913 Lot # Square Footage 2730
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:
' � q
4
-EXEMPTION NOT APPLICABLE'
53080d
Coe
• This certifies that school facility fees imposed pursuant to Government,
in the amount of 1.72 x 2,730 or $ 4,695.60
the property listed above and that building permits and/or Certificates of Occupancy for
f
this square footage in this proposed project may now be issued_.
Fees Paid By Roger Snellenberger & Associates, Inc. r Telephone,, 777- j766
Name on the check ' s
E
• � G � �v Via: } ��
By Dolores A. Ballesteros-
Superintendent
Fee collected /exempted by .Pauline Pearson Payment Received $4,695.60
Check No. 11830
Signature
Collector: Attach a copy of county or city plan checkapplication form to district'copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting