Loading...
9606-124 (SFD)LICENSED CONTRACTOR DECLARATION Thereby affirm under penalty of perjury that I am licensed under provisions of Qapter 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 Date Signature of Contractor t ' 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 isissued. My workers' compensation insurance carrier & policy no. are: Cartier ,a t A 11,1 i' 104i V 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: «i�1� )°+ice 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 PERMT# C°NTR°`" BUILDING PERMIT ��„�'����611 t►121,6n4,1�i DATE %j �9%Sl s VALUATION LOT TRAC71t1A ialih3 JOB SITE C�fltgilj�tidaiais�.��Il�:e APN ADDRESS OWNER CONTRACTOR /DESIGNER /ENGINEER + .+3 F'.h6til.l .tl ,1attel.!a'l.iEb„n.. . ! tf! i'. • . !(°+i i �. +.. e...e. a: .4,,�. ,. a ,a..✓ia.d eA o )k+ {( tn.Pttjt 1519; Vt,)A.kD 1Ai.K..`OL 1E21 1tALN] IJt;,i1+.14T ('rk *!2111 11AIM ItEiyVUl i'A tY22.I1 (010) 'D A ., F ,4ttt ot101 7 =' 7(4s 16ARi,.e'13i USE OF PERMIT >II- t If.i;- i t£gtii,4 t 141<1_1.t.1s'i+ i eq IGA t:.,V 111-` 1101. c.'Ae-11'R IN Oft dt^e11.'1 e"(l,rS;Lititt.•Gft+tJ .Ul'�tNJ;;H . tiA RAtJFf'ARI-( INT t;,Nioft n1F L,: ;t,..,1.1yi;, °."4 t : i "fit f: <`16� 141 NiL. 11.,kNW off.. 1A+,t.`fi?WA1I. f°I;4; 101. AN"'M,0At) X111 S ,sI 1':if;3tC�sf f�f�1� . itif-fiClfi��3it3.-tli►fl 'A1��1 tf1J e.. � e.. qtr �� s. 1 i5 i ••„ a IYi + f 7 l of i ., •y.^ I , - .I'1i�1'.1't-I, !�t- ref : iFri �j�L} %a1. f1t,© u1� I`' I;Zc�f yi% ii I ss 10 i UiiJ420.>-t0) aku:cl� tr�lJeJq,�`•t3ttll•1`fSI41%f�i•;1a ��5••t.)ik.►�dj�•:?-�2 a!+�'i��u .1fYi' Ift 1'� td'�i �:: til �!'€�'3 f2i��+i1: "i ill:fiflfi-'?i5�M119 R �t •?1 ,. .. E41 611 elf+. �{ F i l 'i .�iv10% It �t: vt�j.i Aie� ^y 1 :4 4t 4q tA-i 16t l.�6 ldir.4._ ''g' i� i"'�/,aoi4) �� I,1" D viii (n) 11 AT, erfmirf vvrs-m 1p; Now, $4,474 AN J U L 19 1996 By .. . 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 OP, Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap / F.A.U. Framing Compressor Insulation lie Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Z Final • Final BLOCKWALL AP OVALS POOLS -SPAS ' steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Plbg. Test Final —Underground 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 Final Utility Notice (Gas) 42 ELECTRICAL . A PROVALS 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: - Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500' _14 CERTIFICATE OF COMPLIANCE Date 7(19/96 APN # 604=264-005 No' 14667 Jurisdiction La Quinta , Owner Name Roger Snellenberger f Permit # No. 79085 Street Ocotillo Dr. Log # City La Quinta Zip 92253 Study Area 233 „ Tract # 23913 Lot # 67 Square Footage '2015 ' Type of Development Single Family Residence Comments -No. of Units 1 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 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 Telephone ,777-7766' Name on the check :C By Dr. Carol McGrew Administrator in Charge 'Fee collected /exempted by Pauline Pearson Payment Received $2,707.60 Check No. 12957. Signature PV6�1 X 9 Pn A A k A/1A_ Collector:-, Attach a copy of county or city plan check application form to, district copy_ for all wavers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting