9606-123 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
t;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 #, Lic. Class Exp. Date
1 �+i !
V_10/ 47
Date �"� r ; �? Signature of Contra or t ""`K X -
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&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:
Cartier IaIA111l+UND Policy No. ¢.lt=.+s"•'J,
(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 complyawith%those provisions, s.
Date: " 116 1C, i Applicant R ''� )L .L. � �.... .
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
awlication.
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 sni pection purposes.
Signature (Owner/Agent) '1 ',- w k ..1`*�J' Date'»
BUILDINGPERMIT PERMIT# CONTROL#
DATE 6/2i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade fo
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 to
BLOCKWALL P ROVALS
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
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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)
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
(1'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 9c. Class Exp. D1130/97
Date 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 ownof of the Nlupelly, urn ekdlusively 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 perjuryone 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 ems, �warkers' compensation insurance licy no. are:
Cartier �TB11v� - 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
w w ■ .
y UILDI IT
PERMIT%0&123 CONTROL #
23913 PH63 61 O
DATE VALUATION LOT'
TRACT
JOB SITE "75 OCOTILLO 1DRM
APN
ADDRESS'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ROGER SNELLENBERGER & ASSOC -
ROGER SNELLENBERGER & ASSOC. .
41-865 BOARDWALK, SUTM 212
41-865 BOARDWALK, SUITE 212 •
PALM DESERT CA 92.211
PALM DESERT .... ~...—:,* .CA 9221L!',
(619)777-7766
(619)777-7766... CBL# -1858:_
FE 4F rrnMIT
CHARLES D. GARLAND
SINGLE FAMILY DWELLING
33-163 CATHEDRAL CANYON DR. -
CATHEDRAL CITY. CA 92234
QUINTERRA'
PLAN 1R
TRACT CONSTRUCTION 2,015.00 SF
GARAGEICARPORT 626.00 SF .
ESTIMATED C09T OF
CONSTRUCTION
121,684.10
PERMIT FEE SUMMARY.
PLAN CHECK FEE 101-000-439-318
$597.06
CONSTRUCTION FEE 101-000-418-000
$716.50
MECHANICAL FEE 101-000421-000.
$53.50
ELECTRICAL FEE 101-000420-000
$131.55
PLUMBING FEE 101-000419-000
5154.00
STONG MOTION FEE - RESID 101-000-241-000
$12.17
GRADING FEE 101-000-423-000.
$20.00
INFRASTRUCTURE FEE 2254)00-443-342.
$2,737.89
ART IN PUBLIC PLACES - RESIC 701-000-255-000
$54.21
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,476.88
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$4,476.88
RECEIPT
DATE
BY
DATE FINALE
INSPECTOR
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
x Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 7/19/96 APN # 604-264-004 ,
No. 14666 Jurisdiction La Quinta .
Owner Name Roger Snellenberger Permit #
No. 79075 Street Ocotillo`Dr. Log #
City La Quinta Zip 92253 Study Area 233
Tract # 23913 Lot # 66 Square Footage 2015
Type of Development. Siingle Family Residence No: of Units 1
i
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 amei ssory-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:
i -
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.84 x 2,015 or $3,707.60
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. ,
Fees Paid By Roger Snellenberger Telepi►one -777-7766
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by. Pauline Pearson Payment. Received $3.707.60
Check No. 12957
Signature
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