9606-122 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C'hapter'9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License #Bc. Class Exp: D 12
488234 �� /30/97
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjurythat 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. 7644, 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 ofperjury 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 six& kers' compensation insurance c%gAA fflicy no. are:
Cartier. 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,
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 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 $100,000, in .
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to'cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
CONTROLO
PERMITUILDIN$�4�12Z
46M T 913 PH63 6 9
DATE 6/264VALUATION 1, J10 OT
JOB SITE 7"M OICOTIiLLO DRIVE
ADDRESS
APN
OWNER CONTRACTOR / DESIGNER / ENGINEER
ROGER SNELLENBERGER & ASSOC ROGER SNELLENBERGER & ASSOC.-
41-865 BOARDWALK, SUITE 212 41-865 BOARDWALK, SUITE 212
PALM DESERT CA 92211- PALM DESERT CA 92211-
(619)777-7766 (619)777-7766 CBL# . 1858 .
USE OF PERMIT CHARLES D. GARLAND
STNC,I.F...FAMi,1,Y iIWFT.I,iN[: 33-163 C'ATHEQ1 1" CANYON DIL
QUINTERRA
PLAN 3111
TRACT CONSTRUCTION 2,359.00 SF
GARAGWCARPORT 641.00 SF
ESTIMATED COST OF CONSTRUCTION
140,657.30
PERMIT FEE SUMMARY _
PLAN CHECK FFE 1014000-439-318 5658.13
CONSTRUCTION FEE 101-000-418-000 .$783.00
MECHANICAL FEE 101-000-421-000 566:50
ELECTRICAL'FEE 101-000420-M ' $143.89
PLUMBING FEE 101-000-419-000 $181.75
STONG MOTION FEE - RESID 101-000-241-000 $14.07
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $3,164.79
ART IN PUBLIC PLACES - RESIT; 701-000-255-000 $101.64
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,134.77
LESS PRE -PAID FEES
$0.00 .11
TOTAL PERMIT FEES DUE NOW
$5,134.77
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 9220.1
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 7/31/96 APN # 604-264-003
No. 14765 Jurisdiction La Quinta
Owner Name Roger Snellenberger Permit #
No 79065 Street Ocotillo Dr. Log #
City La Quinta Zip 92253 Study,&rea 233
Tract # 23913 Lot # 65 Square Footage 2730
Type of Development Single Family Residence No. of Units 1
r
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Cod 53080
in the amount of . 1.84 x 2,730" or $5,023.20
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.
4.
Fees Paid By Roger Snellenberger &Associates - Telephone '_777-7766
VQ W.
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted b Al 4 Pauline Pearson Payment Received
p y Y $5,023.20
'Check No. 12992
Signature � +i'02 N, Oe�i% A t AAS
. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. t
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting