9602-029 (SFD)rig
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.
License # LtafG'Iass Da 128 9
'Date Z - Y —9 & Signatureof Contractor // - . t
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).
O 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 section need not be completed if the permit valuation is for $100.00 or less).
( ) I c&iKtliat ih_1b&&Dperformance of the work for whiWA-fisi'permk 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 th/ pr isions.
Date: 2.-�'-� Applicant /C
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 Kris City to enter upon the
above-mentioned property for inspection purposes.
Signature (Owner/Agek) le, 44,4,�16 Dabs
"`C'
BUILDING PERMIT
PERMIT
<sr ► _as�e�
DATE 21 W96
VALUATION $140,651M
LOT 60 TRACT 23Q1-1
JOB SITE ADDRESS
APN
...tea
_A:
444-10
OWNER
CONTRACTOR
RC7t3ER SNE.LX?dR?t'GER & ASSOC.
&,LA1S0,C
4,1fj� B4wuDWAYp'PF212
41,865 80fiitUWALK 0212
€ALWU1'.SLR°T` CA, 7'22211
PALM DURR,1' CA, 92211.
JA I 221a7;P.4466 � 222222
Mtt
DESIGN9k"6INER
ftil 1 77.1'66
CHA1iLE.SD,�yGrii1R�cLANT�
33-163 QL!I.t B'1[.:.i/.kAL CiUIP 14DRZ,
USE OFPERNTT1 p!C1 ! qq��pp� i��yy� 1 7
&1I+iC1ti' FAIVUL Y O YV.[i.L.L'ING
CATTMDRAL C33'">r, CA. 94214
Qulr14l7:o.RA
PL AN 3
FEE DESCRIPTION
FEES
'MALT C0'IJ.SXRLlC-f10N: 2,33.9.00 S.f:
oA1tAQwck0,r,OR'1 64.1.00 81
an Aum con Of CtvmTlTt'1JG'uoN
140.65730
:IPICRA1111 if FEE S>(JNIMARY
PLAN CtMCK FM 1 01-0-43'9-31$
4 O. ISTRIJC'I`1OIN FEE 101400.418-0W $733.06
3vlFLflANICAL x'£13 1.01-000-421-()00 $66,50
Ei:FXTRJC.ALFEE :. 101-000-42.0-000 $143.89
1':LL!MUNG.FrIp, 101-(D00.419 0 ,$182.75
STONG wit3'1~r.ON FM - RESWI 101-OM241-OW $14.07
`aRADINC1:ti EE 1.01-000-42?1000 $20.00
1T+FRAST,1RIJGf1JftE FFE22,5-000-443-342 $3,164,79
ART i?�t PU.t1<i..[� K.,k LS - RESI .0'701.000-2ti5-000 R'1Gl:.fi4
T'AL i,:f-)N4 STPWC"11Q1N AND PIAN C,HKK
$5,134.77
4 LESS 1yd E-PAJD FFES
$0.00
B FF'0O 0 'A1✓..�°.E RMff FE CIS DUE NO`6i�
$5,1;34.77
y 8'7996'
RECEIPT '[DWk
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 J
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOC KWALL PP OVALS
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 t fo
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:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/2/96 APN # 604-262-016
No. 14107 Jurisdiction La Quinta,
Owner Name Roger Snellenberger & Associates Permit #
No. 79100 Street Ocotillo Dr. Log #
Cid,La Quinta ` zip 92253 Study Area 233
Tract # 23913 Lot # 60 Square Footage 2359
Type of Development Single Family Residence No. of Units 1
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 ac-cessory 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 1.72 x '-2,359 or $ 4,057.48
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.
.. 4T
Fees Paid By Roger Snellenberger & Associatesi 21 telephone:777-778'6
Name on the check
By Dolores A. Ballesteros
Superintendent `f�
Fee collected /exempted by Pauline Pearson Payment Received $4.057:48
Check No. 11027
Signature P-."" P
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