9601-009 (SFD)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. 48E234 B 12/3195
License #130.
Date 1_14—to Signature ofContractorctor Q 1✓..F
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).
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.
(J 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 IPolicy No.
(This•sectf6TVK69d_i tZb completed if the permit valuatio'r W6.16 $i 00.00 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 • o Islon ..
rb
ate:& APPlicant9 �aJ9
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000,.in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of India i4l is officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180. days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information. is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature (Owner/Agent) Za�&lDabs
PERMIT
PERM'T,
.BU:ILDING
DATE D
VALUATION • + 'ULOT U TRACT
JOB SITE ADDRESS
794 0 OCOTILLO DRIVE
APN �0� Z�►.$-fl22
OWNER
CONTRACTOR
. • .. .
..
ZOCERSNI11ENBERQER &,.AS
..
.
/Gipl JEwyiG4A��U
j
418�5 BO�AWA�.12i
4190580t`i7;1)WALK #212
t PALM DESERT CA 92211
PA.i;IYI AESER'I" Cts 92211 ::
" (619)777-7766 C13L# , 1858
(61.'19)777-7766
DESIGNER(ENGINEER
CFIARIM D. GARLAND
USE OF PERMIVJJ'4%-YJ 4,R'JU'*{i-[., I 1 VV V,1 VAJ1
33-163 CA.TgDEDRAL CANYON 0M
.
CATI-WX1 i, CIT i. CA 92234 770-7•"
QUI NWRRA - 'f RA41 23913 PHASE 'I!
PLAN 1R
FEE DESCRIPTION
FEES'
'PIACI' CONSTRUMON - - .1,968,00 SF
CARAGE/CARPORT 5$3.00 SF
-
ESTIMATED COSI' OF CONSTRUCTION
118,28910
D'i!"WIT FEE SUMMARY
PLAN (7TTFCK FIRE 101-000-439-318 $495.43
CONS`IitUC:I'ION b'Er. 101.)004184)0 $70ti.f1a7
ME HANIC4L F`Gl 101.000-421.000 s6a.so
ELECTRICAL FEE 101-0420-4010 5,144.04
PL UMBINO:I: LIP, 1 t1 a-44th-4.1'3-t)tJ() $130.00
STONC MOTION FE h , RESID 100'000-241•-000
GRADING FEE 141-0423-000 $26.00
NFRAS"TRUC'CUR FEE 225-0443-342
ART IN PUBLIC PLAMI � RES1D 70 1.-f:}W255-000
SUB -TOTAL C't?NSTRUC"1-100 .AND PLAN CHECK
`:.
$4,335.53
',LESS PRE -PAID FEES
• r
TOTAL PERMIT IT FEFS DUB NOW
$4,385.53
i
RECEIPT
DATE
By,
DATE FINALEO
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings;fj7gDucts
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
BLOCKWALL PPROVALS
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) V a!.Q
ELECTRICAL A O 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)
COMMENTS:
Desert Sands Unified School District
82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619.775_z5nn
CERTIFICATE OF COMPLIANCE a
Date 1/3/96 APN # 604-263-022
No. 14002 Jurisdiction La Quinta
Owner NameRoger-Snellenberger & Associates Permit #
No. Street See Below Log #
City La-'Quinta Zip 92253 Stud` Area 233
Tract # 23913 Lot # 9&56 Square Footage 3936
Type of Development • Single Family Residence ` No. of Units 2
C V W Wts
79-190 Nuevo Thr. na) 968 R� 09- 4.O -06.9-t(10 T,'—'r..0 1968
t
I i
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
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 3,936 or $6,769.92
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 777-7766
Name on the check
By Dolores A. Ballesteros
Superintendent
Yce.collected /exempted by Pauline Pearson Payment Received $6,769.92
1r)N _�
Check No. 10634
Signature N� [� , i �%t- , r nr. n G <<-,.
Collector: Attach a copy of county or city plan check application. form to district copy -for all Raivers.
Embossed Original- Building Dept./Applicant Com - Applicant/Receim Com - Accounting '