9601-007 (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. 4M, 34 13 1.2/ 3195
License # Lic. Class Date
Dater_ cr � Signatureof Contractor 4Z 4
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 3706 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 sectyonf� djrlot�b� completed if the permit valuation�i>3 J_q!i;A00.00 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 th se 6vibions
'Date: t� Applicant �����
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer. to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of kI1e0Wells,Afs officers, agents and employees.
2. Any permit issued"as a result o'of th'Is application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspectin
n puu�rposes.
Signature (Owner/Agent) .�,[/�D� Date N�� Ga
ALCA
BUILDING .PERMIT
PERMIT 60 -097
Y
I
DATE / 1'a►i>
VALUATION J.�� �.� LOT J TRACT _
JOB SITE ADDRESS 7_9490 NUEVO DRIVE
APN 604•-263-022
OWNER
CONTRACTOR
ROOER SNELLENBERGER & ASS
ROGER SNEL'f ]wNBERGER &.ASS
41865BOARMALK #212
4186:5 00AR17'W'ALK #212
PALM DESERT CA 92211 .
PALM DE-sER,r . CA, 92211.
(619)7777.7766 C8L# .1,858
(619j77 7-i7FCa
DESIGNER/ENGINEER
CHAIMES D. GARLAM)
33-163 CATi•II )RAL CAN ►°ON DR.
USE OF PERMITKINGLE I-AMILY DWELLING.
1 I C-4 C112 bi 271: 7
_
f2U1Ni'E}3:t8A TRACT 23913 PHASE ti.
PLAN tR
FEE DESCRIPTION
FEES
'YR&C;1CONB'PUCTI N 1,968.00*1'0'
1GARAGEICARPOWE 583:00 191:
ESTIMATED CaST OF CONSTRUCTION
1,18,2-#9.:$U
PERMIT FEE 9I[JM_M,,kRY
.PLAN CHECK. r� 101-M-439-3.18 $595.43
CONSTRUCnON FEE 101-000-418-000 $706.00
%isf;"11 1.i�i ALE 101.-000-421-000 $68.511
i!IACTfk(Ctlf. F iE 101.000-420-000 $1.44.04
PL-UMBINGf FE79 1011-000-4.19-00() $150.00
STONG MOTWN 1 M3 -'RE SID 100-000-2/11-00 $11.83
0RA1;i1Ni', ,•� 101-0170.423-Q00 $.40.06
11JFRASTRUC'.CURE:F.EE 2 -5-0130.40-342 $2,661.51
ART N 4'11131.1:0pf AC R" -1' ES.Lr 70 t -000-255- MY 0 $28.22
1
'7
SUB -TOTAL O°O STMUCTION AND PLAN CHECK.
$4,385.53
LESS PRE -PAID FEES
$0.00
TOTA.I,11ERM!'.t. IFEES OttE NOMI
T4i3�5t5$
:Ry
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I L
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
BLOCKWAL A ROVALS
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
7A f7yPlumbing
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 P ROVALS
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'
S
Desert Sands Unified School District
82-879 Highway 111
92201
Document Cannot Be Duplicated Indio, CA 6tg_77350t?
CERTIFICATE OF COMPLIANCE
Date 1/3/96
No. 14002
owner NameRoger Snellenberger & Associates
No:
Citv La Quinta
street See Below
APN # 604-263-022
Jurisdiction La Ouinta
Permit #
Zip 92253
Log #
Study Area 233
Tract # 23913 Lot # 9&56 Square Footage 3936
Type of Development Single Family Residence No. of Units 2
Comments
79-190 Nuevo Dr. @1968 & 79140 Ocotillo Dr, @1968
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
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature r fir ,, , OV n'A u '�, 0 Q1e A -A .FYV\,
'Teleplhone777-7766
+!Z
Payment Received `"$6,769.92
Check No. 10634
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