9602-020 (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. 488234 8 --""`7 ' 12�3�f97
License # Lic. Class EXXp. Date /✓'
Date Signatureof Contractor
OWNER -BU ILDER,D5PLARATION
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 prof ct (Sec. 7044, Business & Professionals Code).
O I am exempt under Section =�" B&P.C. for this reason
Date Sig nature of Owner r
`WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
7, `( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided,for by Section3760 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 sectioptieQc �t�l completed if thepermitvaluatioun&Jor1f 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 -.S ion 3700 of the Labor
Code, I shall forthwith comply with thus-psoK1slogs
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.
4;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 resuk.ofpiis applic§ 'on agrees to, & shall, indemnify
& hold harmless the City of Indian^tl46-, itS officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
wbrk 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, pu4Poses -1 ,
,Signature (Owner/Agerrt) 7y -' Daae
ALC "BUILDING
PERMIT •
PERMITi602-020
DATE 2/ { $
VALUATION S1 ZJ,6W4,1<11 LOT 7 TRACT 2391:3
JOB SITE ADDRESS 74-2{115 �1�1.1)1 VO )RIV ,
APN 604-273-007
OWNER
CONTRACTOR
ROGER. SNELLENBr-,RGIER & ASSOC,
P..00/•ER SN.ELL"EN.SEP.i"s'r.R & ASSOC
41865.13
BOARDWALK 11212
4186-5.130WA.LK0I `.,' .
PALM I)ESEwr CA '92211
PALM DESE12.V,• CA 92a1l
(619r, -77-7766 C.BL0 18.558
(619)777=7766
DESIGNER/ENGINEER
CiiARLFa D, C;APJ.AND
33-163 CATHWRALCtiSVONDR.
USEOFPERim1rjINQ F, FtkA41LY 1.yWELL1.l Q
I- c. P_ v 0A 0"'IA
PLAN ,1
FEE DESCRIPTION
FEES
:7,'RAk-r CONS'1''RUC''TION 'Zo15.00 3F
CARAOF AR ORT 1626.00 S1±
ES°flMMED COST .OF CONST.RUCTION
.12,1,6i4.'10
PERART FC, F, SUMIKARY
LA4,Nft 01 :F-ErT l.Ql.4)0-A39-318
CONa'ZRUCTfON FEM 101-000.44000 $716.50,
?vIECHANI CAl. "FTE 1.01-000-421-000
ELECTRICAL M :101-000.420-000 5131.5`
FLVfMBI1`fGl.�l 101-0004!9-000 SaW,00
S1`ONI G MOTIO;d M! E - RESID 101-000-241-000 $1237
ClkADINLIFEE . . 101-000-423-000 92€6.00
rM7kA'S7'a C�IVRF, FEE 225.000-443342 S2,737,89
4 11:114 PUBMC, PLA.07;8 - PF6M 7014titl0-25.000 $84:21
' 'Ri»1C'f1tJN ANl3 Pit --N C21 xx
se,476M
Q fl USS 1,,%11;-1 AID FEES
$0.00
D L�
AL :PEMlifFEES DUE NOW
FEB.
S44476.88
-0 6 1996
RECEIPT I
DATE
BV
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPRO ALS
MECHANICAL APPROVALS
Set Backs IUnderground
Ducts
Forms & Footings vDucts
Slab Grade
Return Air
Steel _
Combustion Air
Roof Deck 114 Z v
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 A0PR6VALS
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 Ml
Heater Final
Water Piping v IPlumbing
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) ) XqE
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) ti � 17 0
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14096
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 79205
City La Quinta
Tract # 23912
Type of Development
Comments
Street Nuevo Dr.
Lot # 7
Single Family Residence
Jurisdiction
APN # 604-273-007
La Quinta
Permit #
Log #
Zip. 92253 Study Area 233
Square Footage 2015
No. of Units 1
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 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 Tele0hone 777-7,70
Name on the check
By Dolores A. Ballesteros�:,
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,465.80
Signature a A ► JI A'A 1' L"�
Check No. 11027
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
A