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9711-114 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of'the Business and ProfesPnals Code, and my License is in full force and effect. ZLit nse # Lic. Class Exp. Date 488234 B 12/31/97 ate 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 S Professionals 0410: ( ) 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, forthe performance of the work for which this permit is issued. 0 I have and will maintain workers' compensation insurance, as required by S2ction 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: Camer STATE FUND Policy No. 6263559 f 7 „. (This section need not be completed if the permit valuation is for $100.00 or less). ( ). I c rtify that in the performance of the work for which this permit is issued, I shall of employ any person in any manner so as to become subject to the wor)iers. compensation laws of California, and agree that if I should become S ject to the workers' compensation provisions of Section 3700 of the Labor ode, I shall forthwith comply with those provisions. ate: Applicant 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, indemnity & 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, pr cessation of work for 180 days will subject permit to cancellation. Icertity hat I have read this application and state that the above information is corre . I agree to comply with all City, and State laws relating to the building con ruction, and hereby authorize representatives of this City to enter upon Zth above-mentioned property for inspection purposes. ignature (Owner/Agent) Date f'I 1�= PERMIT # CONTROL # BUILDING PERMIT 9711-114 5130,154.60 8 DATE Z f 3`71 VALUATION LOT TRACT 20-4 j 7 4` JOB SITE ADDRESS 3-682 PALERMO COURT APN 613 09-080-0 OWNER CONTRACTOR / DESIGNER / ENGINEER THE EXCHANGE GROUP, INC ROGER SNELLENBERGER & ASSOC. 1 FLORENTINA DR 41-865 BOARDWALK, SUITE 212 RANCHO MIRAGE CA 92270 PALM DESERT CA 92211 (760)777-7766 CBL# 18.58 USE OF PERMIT SFD- SFD LOT 8, PLAN 4BR TRACT CONSTtZUCTION 2,200.00 SF PORCH/PATIO 110.00 SF GARAGE/CARPORT 471.00 SF ESTIMATED COST OF CONSTRUCTION 130,154.60 PERMIT FEE SUMMARY CONSTRUCTION,FEE 101-000-418-000. $748.00 PLAN CHECK FEE 101-000-439-318 $618.74 MECHANICAL FEE 101-000-421-000 $60.00 ELECTRICAL FEE 101-000420-000 $134.92 PLUMBING FEE 101-000-419-000 $140.75 STRONG MOTION FEE - RESID 1014000-241-000 $13.02 GRADING FEE 101-000-423-000 $20.00 INFRASTRUCTURE FEE 225-000-443-342 52,895.56 ART IN PUBLIC PLACES - RESIC 701-000-255-000 $75.39 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,706.38 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $4,706.38 RECEIPT DATE BY DATE FINALED INSPECTOR LICENSED CONTRACTOR DECLARATION I h6rebyaffirm under. penalty of perjury that I_'am licensed under.provisions of 4'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 #> ', Lic. Class Exp. Date Y altJE1 M13 12/97 l ' '�) spate , }, i !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:: + ( 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). (- 1,.as owner of the property, am exclusively contracting with licensed contractors, to construct,.the project (Sec. 7044, Business & Piofessionals Code). s O, I am•ezempt under Section „B&P.C. for this reason Date < Signature of Owner WOR,KER'S'COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of. the following .declarations: ( .) l.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 certify that in the performance of the work for which'this'permit is issued, ['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•6f the'Labor. CodeI. shall forthwith comply with those provisions. Sate rD e7�/,APPlicant Warning:: Failure to secure Workers' Compensation coverage is- unlawful. and shall subject an employer to criminal penalties and civil fines up to $1.00,000 '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 Correa -1 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 inspeon purposes. ; Signature (Owner/Agent) y Rt• _ -.,Date-,D Il �. r ..f. BUILDING PERMIT PERMIT# CONTROL# BUILDING•� 'gyp DATE.. VALUATION gl ),`�t•�9i�' LO—T�� �S .TRACT. t ,,Q� JOB SITE ADDRESS401!�"�c`ir� .`. APN OWNER. 'CON TRkICTOR/DESIGNER/ENGINEER THE, FlKi,!- !MANE l:rit�1UP, INC ROC117 .. t ]V (,QUr'TTINA DLL 4.t 865 130AR*bW't'J,!C.. -SUI t. "2,2 RAkC11011r1WA. CA. 02170 k'AA:; A DSI1111' CA. 922,11 USE OF PERMIT �91.)LOT 8.K'AN41312 r. • a �!Y Fv'N I++•��,,Yy♦0,x•1 r�ryN. ,,,++--��[ h M/1 a� frt'^ l.fCi�.4i 4P+JbVSIVRlXINGN 6�A` k,110 ZM1 • ���:se�,�i'=�}cry; i:ltb.t�a �s� . = R_'S#.T`��'I1.XTTw.I3 .%tJi :0.fi8r '6Jly � a.9.s'4 sus. �.vS.'eT t.''O7+7STRE11C'f'ICIN FOR 101-000-418-000 S�4Y �lti s PLAN CHECK r+"F,. 101--flf 0-1439) 3 D R 'VA8,74 .t . 13:t;:��`t1' CAt,:l��:. .. it31�1iPdall(i-Olid $u K. 1'Lt 1:i1NlshL it)1.<OfJt?-�Xti+-tlOt1 5140,7 r�PY4�i"•!-frO. �fdli2(��441.Jt13ppp(4yy:rJ1�3yflfl Q1,dy�M� 2%.IHL'U•L+V A�T v� 'R F iS.3`r AkT W failf$L'.li, MIC 701-i3W-2.55-WOLAJ ., 19USt I'MAL CKWST"RUC110N AND (1114"EqC79 K $4;7{'t�!� y�;,,yF,��'I..AIN( r�{ 3�9 X8 ; `1?!®.1<VV M 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 Glade 7 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.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 —yff Zz! BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover • Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 7 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping _ Gas Test Appliances Final Final Utility Notice (Gas) ' ELECTRICAL A PROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power 'Final Utility Notice (Perm) COMMENTS: