The URL can be used to link to this page

9712-050 (SFD)LICENSED CONTRACTOR'DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ch ;pter 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 3 1 E- ?."13Ii97 4 ,/DateSignature of Contractor�t - } - •OWNER -BUILDER DECLARATION % 1 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). ( ) 1, 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 -6y Section 3700 of the -Labor Code,.for.the performance of the work for which this permit'is issued. ( ) 1 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. SITi 1'F F -u'.40 (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, 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 I should become subject to the workers' compensatiori provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,Date: 1"; f 1'r1. Applicant—- t.-11 1, Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000,16 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. f. ,,Signature (Owner/Agent j! 1 Date �Tj� f PERMIT# CONTROL #;7,;*.: ' BUILDING PERMIT:�� DATE VALUATION�,1,xiii�,4�l LOT 1 z . TRACT + 1 ®. JOB SITE ADDRESS 43•<.79,i .'P.4 �,i�l b7A [IV9.iTT APN OWNER CONTRACTOR/DESIGNER/ENGINEER THE EXC14ANGE GROUP RCW;Kk SNEIA,L'NBir12.C11=k Vii, ASSOC. 10 BOX 1333 79615'NAP1,135 DRNF, A (AJANTA. 92253 PALMI DESEM' CA 922.55. P.Ai:M DESERT. C. A. 022.55 (? r} 77-2 22 r l;,-0 R USE OF PERMIT - Sl�l:� I •: x R LOT 12,.'P1.AN SB SE17 - PER"T DOES NOT MCLI(.i)E BTIOCZ{ WAILS OR VL3CIL. AA ' DEC 10 1997 y��q��/p �U�,..lY.`4.1 ill 4Vli fJt1 >C� f ` QQ ��y� �l �UIi�E?IA p C3ARAGWCARPORT a J.Q0 Sr k ESTIMATEDCOST OF CONSTRUCTION1 PERMIT FEE SUMN9( kRY WN.' rRUC rION FEE 101-000-418-000 PLM CHECK kffi $64791 WCHANWAL FEE 101-000-42'!-000 S61100 J OI -000-420-00() $141A8 PLUNI[R. NG FEE 101-10M419-000 $140,75 STRONG X10TION Fly - M810 101-400-211-000 x.11.12. GRADING FEE '101-000-423-004 S2r);cJct 1.14FkA,':f'Rt CTI)RE FEE 225-000-44.3-342 ART IN PUBLIC PLACUS - RT:,SIC 701 ^000-255-000 $1.03.1? SUB -TOTAL CQNS'IRUCT'ION AN13,1?1,AN CRECI,'.. $5,044.09' 11.1ssS P11r.-PAID FEES ,$t IX) YOT 1L, PERA41T FEES DUE NOW $5,044.09 .:r r-": RECEIPT DATE BY/ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE T INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings / Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -Z — 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 - — BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS 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 _a./ — 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: LICENSED CONTRACTOR DECLARATION I hem -by 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 Professionals Code, and my License is in full force and effect. ZL'cnse # Lic. Class Exp. Date 488234 B 12/31/97 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. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&RC. 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. AI have and will maintain workers' compensation insurance, as required by on 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. STATE FUND 626355-97 (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 permi6s issued, I shall not employ any person in any manner so as to become subject to the wo�ers' compensation laws of California, and agree that if I should become Syblect to the workers' compensation provisions of Section 3700 of the Labor ode, I shall forthwith comply with those provisions. Date: 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 yvhose 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, 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 corrgot. 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 t above-mentioned property for inspection purposes. Signature (Owner/Agent) `' Date . BUILDING PERMIT PERMIT9#7124M CONT VALUATION $141,2.40 LOT 12 TRACT O DATE a/10/q,7 48 DOB SITE DRESS43-591 PALERMO COURT AP" 609-080-013 OWNER CONTRACTOR / DESIGNER / ENGINEER THE EXCHANGE GROUP ROGER SNELLENBERGER & ASSOC. PO BOX 13335 78615 NAPLES DRIVE, LA QUINTA 92253 PALM DESERT CA 92255 PALM DESERT CA 92255 (760)772-0222 CBL# 1858 USE OF PERMIT SFD LOT 12, PLAN 5B SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS. OR POOL. TRACT CONSTRUCTION 2,400.00 SF PORCHIPATIO 160.00 SF GARAGE/CARPORT 449.00 SF ESTIMATED COST OF CONSTRUCTION 141,248.40 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000-418-000 $786.50 PLAN CHECK FEE 101-004439-318 5647.91 NWCHANIN CAL. FEE 101-000-421-000 560.00 ELECTRICAL FEE 101-000-420-000 $141.48 PLUMBING FEE 101-000-419-000 $140.75 STRONG MOTION FEE - RESID 1014)00-241-000 $14.12 GRADING FEE 101-000-423-000 520.00 INFRASTRUCTURE FEE 225-000-443-342 53,130.21 ART IN PUBLIC PLACES - RESM 701-000-255-000 $103.12 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $5,044.09 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW 85,044.09 RECEIPT DATE BY DATE FINALED INSPECTOR