9601-011 (SFD)__Ah�.
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. 488234 13 ' 12/ 3193
License # Uc. Class Exp. a _
Date Signature of Contractor
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),
( )- 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This secti6li;h'&6d• o completed if the permit valuatic*64 66,4100.00 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 pvision!!" ion!
Date: i- t%— `� �o 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 resylt_of%s application agrees to, &shall, indemnity
& hold harmless the City of-IRdihlh l ell's 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 inspec 'o, purposes.
Signature (Owner/Agent) Date
ALC 0 --
BRUI INTERMIT
n PERMITyDr�D�
DATE
VALUATION "" " "T` LOT
t
TRACT
.
JOB SITE ADDRESS 79430 OC.0711L.W DAVE
APN�-262-1123
OWNER '"
'CONTRACTOR
Ruomt S1 r -.i.- ,1rI B.r-,RGE & ASS
ROGER. SNELLENEERGER & ASS
4186513J.Ak:1)WA,LK 11212 `
4i86-5 BOARDWALK fi2.i2
! r':e1W D.EESrRT' CA 92.211
PALM DESV'Wf CA 9221.1
019)777-7765 CBL.# 11151+
(61.!0777-77(6
t .
DESIGNER/ENGGI EER
:i1 aHl4t� a 1), OA AND
•^r�vr-.r - n R s.rvr �r vy
3J-163.�.`►�1.�.11iE'17Ri,L CANYON DR.
USE OF PERMIT' • " s r, ate.
C/#1 F 'i RA:i. =V,CA 9:X34 770-7
QU.IN41NRj1- IRACI'23913 PHAS1.1I
PLAN 2
l
FEE DESCRIPTION
FEES
TRACT CON'ST.fttDL:' ION ?,132.00 Sit
.PORCIVPIMO $2.00 SP
CARACL=/CARPORT. ; ` 59;.00 S1;
t
1"�,�TP"TEiD COST OF CONSTRUCTION
1.29,559.40 ..
PERMIT FEE SU 1%11MAilt'1r'
P3 N CkTCK FEW 101-000-439'-31:8 $6118,71
CON:STRUC1 ON F EF, 10.1-000418-000 $741.00
NI>-.CHAWCAL r-- 101-000-421.-06111 ,$55.50
ELECTRICAL FEE 101.000-420.000 $150,06
PLUMBING 17"11 10I-000-410-00,0 $150.00
S'1'ONti MOTiUNFEW, - IMSID 100.000.241-000 512.56
v�Rtii?I1`FC3 T ER 101•-()00423-00(} $20.00
INFRASTRt.1C TURE`FW 225-000-443-342 $2,63613:05
ART M PUBLIC PLACES . ;t EME 70.1-000-255-000 $11,4.0
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,687,58 .
LESS PRE;PA.T1`i PEES
$0.00
TClTAL :P:EILMIT FFMS 1) TE NOW
$4,4597.53
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPR VALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings )
Ducts
Slab Grade v
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 o
POOLS - SPAS
BLOCKWALL APOROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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 t o
Utility Notice (Perm)
Desert Sands Unified School District
82-879 H ighway 111
..
Indio. CA 92201.
.Document Cannot Be Duplicated 61 Q_77C%_;inn
CERTIFICATE OF COMPLIANCE
Date 1/3/96 APN # 604-263-023
No. 14001 Jurisdiction ^ La OUinta
Owner NameRoger Snellenberger & Associates Permit #''
No. 'Street See Below
City La Quinta Zip 92253 Study Area 233
Tract # 23913 Lot # 8 & 57 Square Footage '4100
Type of Development Single Family Residence No. of,Units 2
79-2.1111 Nuevo Dr. no. 1968&Q9.�X;0_O.coti.l.lo_T)ri> Ca 7.13_?
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 at-ove-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 4,100 or $7,052.00
'!he 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 Tel'ephore ' 777-7766
Name on,the check
By Dolores A. Ballesteros
Superintendent
Fec collected /exempted by Pauline Pearson Payment Received X7,052.00
,� Check No. 10634
Signature rc ) A, Q rv%'
Collector: Attach a copy of county or city plan check application form io.district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting