9606-125 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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.
License # Lic. Class Exp. Date
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 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 E—
< ;
Date -1.o {t" 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 S'%'ii`i'1317[IV1► Policy No. Ci #.3S9S
(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 provlsions.of Section 3700 of the Labor
Code, I -shall forthwith comply with those provisions.
Date: ? - L Applicant /� - •r
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 2
BUILDING PERMIT
PERMIT# CONTROL#
r�.rza 3587
DATE VALUATION LOT
7l1IM 5140;457..N0
TRACT
2391; 1446
JOB SITE
APN
ADDRESS 7.9-095 ��C.�.�`.��..�sO URI.` E
OWNER
CONTRACTOR/DESIGNER/ENGINEER
fetJC; ;E:, S1ti1 f,1.:I 1�1' 1,C�t`11 i; 4 t1.i.�"iC3�
ROGER ASSOC.
4i-865 80A#W1 ALK, SUrIE 212
41-865 BOARMALK, SHITE 212
VAL&I k't1;CE;`.l T CA 921 i I
VA1.M M.S R1' CA 92211
Po19i777-77t,
(610177'I -771,6 E858
i;�i�lliL IMS Lt. C3f�Ezl;rai�Tl7
USE OF PERMIT
SINGLE PAMILY i. iWE1s.l.,fNG
CXIIl,EORAL CANYON OR.
E:At3llif RAl<(1 TV. C;A9':1•1
`IRAC; f t:ONS'FRUC" 10N ,'„t ,lN> SIS
GARAOCICARP0RT 64J,00 Sia•
FS•1'3MA`l ED COST OF CONS7`RU( "CION
:160,657.30
:'VER 41 Y FEE SUMMARV
'0.AN0iftC.`K Vit;R
$658.13
i:•0N..TFRtlt;T10N Fi4`ki
$783:00
Ati;CAAN),CAI:. {.EF
S661 9)
ELEC' RICALf'M 1,01-000-420-000
SK.K8t
!'f:t if+hRE Nc; %difi
S"►•OhtG MOTION FEU -1: UM) 10! )00241- t'00
GRA;LiiNO i:'EF 101. 000_423_000
�t0.tttt
fNf: fZAa"312z 1C R IdRE FEE 225-M-40-341,
S3, !(A.7f
AIRT IN F'UBLIfi .K,ACE 8 - REST 70 l -000-235-ON)3ltj
l .C�4
SUB 1WAL CONSI RI..tC`i'104V AND
PLAN C HFCK
$5,1,14.77
O 4 LESS PRE-PAJD .PtRES
$0.00
y
D"Cf3'C:.
L f'%:.tti'4 IT FEIk?,S
DUE NOW
$5,134,77
i
ilk
12 1996
ey
RECEIPT \
E
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 fCombustion
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 Or
-7 eot
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APP OVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping LA
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 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)
LICENSED CONTRACTOR DECLARATION
I hereby 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.
Licensee bc. Class Exp. D12/30/97
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 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 rs' compensation insurance licy no. are:
Carrier �e 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
DATE 6,�1� U I VALUATION VI IToT
PERMIT96�12 CONTROL#
9.13 PH63 6 12 J
T�?�
JOB SITE
ADDRESS
7—
OWNER
CONTRACTOR /.DESIGNER/ ENGINEER
ROGER SNELLENBERGER & ASSOC
ROGER SNELLENBERGER & ASSOC.
41-865 BOARDWALK, SUITE 212
41-865 BOARDWALK, SUM 212..'.-
PALM DESERT 'CA 92211
PALM DESERT. CA 92211.' .
.(619)777-7766
(619)777-7766 CBL# -.1858., .
CHARLES D. GARLAND
USE OF PERMIT
SINGLE FAMILY DWELLING
33-163 CATHEDRAL CANYON DR
CATHEDRAL CITY CA 922364
QUINTERRA
PLAN 2
TRACT CONSTRUCTION 2149.00 SF
GARAGEtCARPORT 597.00 SF
ESTIMATED COST OF
CONSTRUCTION
12091.90.:.•
PERMIT FEE SUMMARY:
PLAN CHECK FEE ..101-000-439-318
$615.61 .
CONSTRUCTION FEE 101-000-418-000
$741.00'
MECHANICAL FEE 101-000-421-000
$53.30
ELECTRICAL FEE 101=000420-000
$135.66
PLUMBING FEE 101-000419-000
$154.00
STONG MOTION FEE - RESID 101-000-241-000
$12.84
GRADING FEE 101-000-423-000
$20.00
INFRASTRUCTURE FEE 225-000-443-342
$2888.82
ART IN PUBLIC PLACES - RESIC 701-000-255-000
$70.98
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,692.41
LESS PRE -PAID FEES
$0.00 • ;
TOTAL PERMIT FEES DUE NOW
$4,692.41
•
GLLJ
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Notice:
Document Cannot. Be Duplicated
Desert Sands Unified School "District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 7/10/96 APN # 604-264-006
No. 14678 Jurisdiction La Quinta-
Owner Name Roger Snellenberger Pe'mit #
No, 79095 Street Ocotillo Dr. Log #
City La Quinta Zip 92253 Study Area 233
Tract # 23913 Lot # 68 Square Footage 2359
Type of Development Single Fanily Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect feeE 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 2,359 or $ 4,340.56
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 & Associates f.,t Tele none 777-7766:.
Name on the check
By Dr. Carol McGrew
Administrator in Charge ` rJt' '`i +} '
Fee collected /exempted by Pauline Pearson Payment Received $4,340.56 „
Check No. 012833
- Signature Pa 12 hAltU LU'40/vL
Collector: Attach a, copy of county or city plan check application form to district copy for all waEvers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting