9512-010 (SFD)LICENSED CONTRACTOR DECLARATION
I Hereby affirm 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. 488234 B 121 V95.
License # Lia Class e-'-Exp,Dats
Date tx i ig S Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm 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).,
O 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, 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 sectj9pp?EdrL9tAe completed if the permit va1uatio�nj8J95$,100.00 or less).
( ) I certify that in fie 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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply witIrtk�ose pro` iisions.
Date: 42,.i'`i5 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, intarest 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 ot#16} plica§oogrees to, & shall, indemnify
& hold harmless the City of tndian-We1ts;'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 pro arty for inspection purposes.
Signature (Owner/, ?�*"— �' Date
T:.
ALCM
BUILDING PERMIT
PERMITS
DATE 12/4/95
VALUATION $1.18,U9.2C LOT. , 61TRACT '239.13
ri '
JOB SITE ADDRESS
79-4 90 0C�8`C'i t,C?.0 ��
APN
604•-26"17
OWNER
CONTRACTOR
ROGER SNELLENBERGM & ASS
ROGER SNE'LL N B.F Klr.-R & ASS
41865 80JVR.DXVALK #212
41605 BOARDWALK #212
'PA[:M UESEXT CA 92211
PALM U:ESEWr CA 9271 f
(01V)777.7766 C;BL#. 1856
<619)7"77-77£6
DESIGNER/ENGINEER
CH ARLPS .L', GAnAMD
33-:163 GATIIEMNA1. Cr'NDR-
USE OFPERrVuT�ft,'G[ , i+At'V11LY DMELLNG
PL AN IR
FEE DESCRIPTION
FEES
TRA.CTCONSTRUCTION 1,968.00 SF
GARACi'OCARPORT A83-00 IiE
TIMATE COST OF CONSTRUCTION
11.8,.250:211
€ ERAI Y FEE SUMMARY
ILANCET-F.a'"'K FFFF, 101-000-419i316
CON'STRUCTIONFBE 101- 000448-000 S70,6.Q0
MECF"CAL FEE 101-000--421-W 518.50
f}"SCTRICAL IFf:6 ..101-000-420.00;0 $:144.04
PLfJNtii1NO FU 101=0017. -41.9 -WO $150.00
STONG• IVIOTION. FEE - ROID 100-000-241400
GRA131NOFEE 101-000.423-000 $20.00
rfa" AJ'MUCTUiRE FEE 225-M-443-342 $2,661.51
ART IN PUBLIC PLACES - RESI1; 701-000-2,55-000 $28,2
SUB. OTAIL CONSTRUMON AND PLAN C}�cK.
VX5.53
1LESS PRE -PAID FEES
$0.00
F.1''.• ' S DUE NOWS4y385.
r -
3
�E� 0 � • -
1995 :
.
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 f f YAFA
Exhaust Fans
O.K. to Wrap "L-Jpb
Framing
F.A.U.
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 PPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
. Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping a 4.
Plumbing Final
Plumbing Top Out 17 117Equipment
Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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:
-
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/5/95
No. 13933 Jurisdiction
Owner Name Roger Snellenberger & Associates
No c79090 Street�Oc_otillo
City La Quinta zip 92253
Tract # 23913 Lot # 61
Type of Development Single Family Residence
Comments
APN # 604-262-011
La Quinta
Permit #
Log #
Study area 233
Square Footage 1968
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect feed 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 Coale 53080
in the amount of 1.72 x 1,968 or $3,384.96
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.
`cam =n
Fees Paid By Roger Snellenberger & Associates, Inc. _,4 ieleRhone 7772166
Name on the check.r' s
By Dolores A. Ballesteros
Superintendent y� _
Fee collected /exempted by Pauline Pearson Payment Received $31;384.96
Check No. 10308
Signature \C k^c a a Q ► /V\ -k . ?�_�,k nA-6/vl-
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