9602-028 (SFD)LICENSED CONTRACTOR DEC6RATION
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. 488234 8 _.,�i2130i97
License # Lic. Class?LARATION
Exp. Date"• .✓���
Date Signatureof Contractor OWNER-BUILDDR
I hereby affirm that I am exempt npo a Contractor's License Law for the
following reason:
() I, as owner of the properly, 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 proje�ct:(Sec. 7044, Business & Professionals Code).
O I am exempt under Sectlom _- B&P.C.,rd'r�his 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;"Q Section 37001of 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 secti? ��e,gcVo,��e completed if the permit valuatiodn iS Jq $ 00.00 or less).
() I certOat In the performance of the work for whic4is 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
W,
Warning: 'Compensation coverage is unlawful and shall
subject an employer to c�rirrinal 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 Indlan�Vllells�itiQficers, 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)
A"'BUILDING
.PERMIT " _ .
PERMITt
�6,,,-aux,.
DATE ` / 6196
VALUATION 5. J,0 .1u LOT l
TRACT 2, 19 1 J
JOB SITE ADDRESS
79 110 OWTi(LLO URNF
APN -
604-2621185
OWNER
CONTRACTOR
ROGER. SNELLENBE11G.ER & ANS<: C.
FtQCER ,,�Np-, 1..EW 3rttGL4 ,.& ASSOC
41865BOARDWALK #2;11
41865 80iU i' W1V.I:. 4212
PALM DESEKF CA 92211
PALM DESERT CA, 9221.1
(619)777-7766 1€58
(619)777-7766
DESIGNEWENGINEER
CHARLES D. GART AND
3.3-163 CATI%Z DRAL CANYON DR.
USE OF PERNSIr1GLE 1{A1b1 Y DWE LLIIVG•
Qtnlar AtRA = '�
PLAN 1•, • .,:
- FEE DESCRIPTION
FEES
IMA4^'1' C0f4 'MUCT10..N SC
GARAQWCARPORT ! 6^6.00 SF
FISTIMATED CaST T OF CeaivSTRUCTION
121_.68446
PERMIT i fi% SIJMMAR.V !
?�
1'LAN CHECKFIT 101-000-439-4 R5r[.06
CONSTRUCTION.JUE 101.000418-000 $716.50
MECHANICAL FEL' 101-000-4'21-000
�
.h1EC:fRIC:ALFEE 101-00042,0-000 $Z�i:SS
cfl
1?3:1 kF11�tO:E r 101 -OO( 419-000 $154.00
lQ rn
STONG Ib10T'111014 FIM- -1'' ' `.ID 101-000-24t-000 $12,17
`—
Off Ab [NO EES 101.-000-423.000 $20.60
�
1NFRA5 TRUC fUi E4 FIEE 225-(100-443.342 $2173709
O
a ix
.A" 10 PUBLIC .LACKS - It C?•SLI: 701.-000255-000 &54.11
UJ
C
SiJB-TG.1'A` L COAT91RUCTION AND PLAN CHECK
11;476.83
,ESS PRF -.PAID FEES .
$0.00
TOTIM, r E RMITFEE, S DUE NOW
$441C
RECEIPT
DATE
BY
DATEflNALED
INSPECTOR
INSPECTION RECORD A.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
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
POOLS - SPAS
BLOCKWALL PPROVALS
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 q, 14 b
Plumbing Final
Plumbing Top Out V1Equipment
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 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)
M
lA
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway Ill
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/2/96
No. 14106 Jurisdiction
Owner Name Roger Snellenberger & Associates
No. 79110 Street Ocotillo Dr.
City La Quinta zip 92253
APN # 604-262-024
La Quinta
Permit #
Log #
Study Area 233
Tract # 23913 Lot # 59 Square Footage 2015
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 ori garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached ac-.,essory structures or
replacement mobilehomes. It has been determined the above-named owner is okempt 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 2,015 r or $3,465.80
the property listed above and that building permits and/or Certificates of Occupancy for
a this square footage in this proposed project may now be issued.
Fees Paid By Roger Snellenberger & Associates > , Telephoue777-77'66
Name on the check ti•, y n '
By Dolores A. Ballesteros
N
Superintendent,
Fee collected /exempted by Pauline Pearson Payment Received '$3.465.80
D P Check No. 11027
SignatureAl Al d
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