9602-027 (SFD)= LICENSED CONTRACTOR DECLARATION
I here 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. 4,38234 13
License # Lic. Class EXp."Date—,-
Date Signatureof Contractor ira _`Z's''
OWNER -BUILDER DY-CLARATION
I hereby affirm that I am exempt frorn.4he 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 exclusivelyY 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 3700fof 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 sectio need r ty& completed if the permit valuation,is,190,100.00 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 provi�Sions of Section 3700 of thee1kbor
I Code, I shall forthwith comply with those -pro isions
Date: Applicant
Warning: Failure to secure Workers' • mpensation coverage is unla I and shall
wSubject an employer to crim n penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
:" ofrthe
or Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the•Direct 'r 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 apnpli c tion, agrees to, &shall, indemnity
& hold harmless the City of IndiBr�-Wells i 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 804days 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 purposesr?�
Signature (Owner/Ager!) Dabs
"`C'
BUILDING
PERMIT
PERM',D'�
DATE.2( 6j/96
VALUATION 5121.468441
TRACT
JOB SITE ADDRESS
7.9-.120 OCOTILLO DRIVE
APN
604-26242 '
OWNER CONTRACTOR
.ROGER SN-gEpl'�.T,;�NB,B.R.OER, & ASSOC.
('�/-r
������w'''� pp r t �y p�''+t, �y ASSOC
O EK a t li,�`LLfL'� N-18El\'GE P, &11:, SOC• � �i,t,Q-65 B�J.I'.ULt..J� oarALIK'.
41865 .80niiD4ir.=1iic. rf= PALM DESERT CA. 9°71'11.1
L A[Aflj�l•�,'SE.W1' CA. 92211 (619)777-1766 IR58
(f 19)777^77166 DESIGNERIENGINEER
,»l CHARLES l3. �'ir1T2LAItit19
USE OF PERIMI,314131LX, 31 ,'t ILY.DWEt,.l.:ING 33-163 CATI=R-ALCA Y014UR,
a.= ,• a•' +r [:� nn -e
.. tG
PLAN t:
FEE DESCRIPTION
FEES '
"t RAC"1' CUNS'i'RUCf1014 : U.15.00 SF'
CIARAG1s/CAkP0,R`f° 626.00 SF
F—ST IMATE;D COST OF 'CONSTRUCTION
121,684,10
P @3� 11 T FEE SUMMARY
I AH C1M alt IFF E 101-000-439._318 $597,616
CONSTRltMO2dF1PX 101-001-418-000 S7I6.50
_ --Vl)_3CHA 1CAL.rEE 101-000-421-000 X53.50
1~UCTRICAL FIX' 101-000-420-000 X131.55
01)
`�
11,11 1BING FFS 1.01-00OA19-400 1s .
STONGMOTION.' -IMSID 101-000-241-0001 $12.17
a
GR ING Fid 710%- 710(}-=123-000 24�.rfi
; tJ�r
WI --RA: 'RUC'1'URE147FE 225-000-443-342
LL
iWT.1NFUBLICPLACES -RFISI 7101-00M5.5-000 $54.21
r
SUB -TC YrAL G:C..tNSMUC SON AND ,PLAN CHECK.
$4,476.88
LESS PRJ:-PE1%:t) ,i' EES
$0.00
TOTAL PERNI9 , MEES DVE NOW,
$.+,476A -
RECEIPT
I DATE
BV
DATE MAILED
INSPECTOR 771
INSPECTION RECORD
OPERATION
DATE
INSPECT
OPERATION
DATE
INSPECTOR
BUILDING APPROVAL
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
44
11r— AV
Final
Final
BLOCKWALL APPROVALS
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
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
FinalAf
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School.District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/2/96 APN # .604-262-024
No. 14105 Jurisdiction La Quinta
Owner Name Roger Snellenberger & Associates Permit #
No. 79120 Street. Ocotillo Dr. Log #
City La Quinta zip 92253 Study Area 233
Tract # 23912 Lot # 58 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 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 -Ixempt 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 or $3,465.80
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 �= Telephone- 777=?'766
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3.465.80
Check No. 11027
`Signature Pil a �2/lit0 Fly �Al�'�
Collector: Attach a copy of county or city plan check application form to district copy for all wai-ers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt; Copy - Accounting