9601-013 (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. E1gg234 .1i 1`2/ 3195
Licens # Lic. Class Exp.
Date •� �/.
Signatureof 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). s
( ) 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 sectfqnRd1 o,Tr$_9 completed if the permit valuati%n�l�195f400.00 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 tijosrovislelja� /j
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 resultof,t�hiis'application agrees to, &shall, indemnity
& hold harmless the City c(f lnd bt5.tdlellAts.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 inspe-gfign purposes.
ygignature (Owner/Agent) Date
ALC
BUILDING PERMIT
PERMIT ;60113
DATE
VALUATION S 140,2 50.6ff LOT 10
TRACT 23913
JOB SITE ADDRESS
,fig -180 NU i'VO ,ii RI +�'
Al
APN 604-X3Ibv
OWNER
CONTRACTOR f +
:fi.M.FR, SNELLENBER.GER &, A&
ROO1 R SNIEL1. ENBERGER &ASS41865
BO,�.s't.DNVALK 9212
4186513C2Ei1Z1AVALK 11212
i I3tiLi IDES.ERT CA -92211
PALM DESfSU CA 92211
(619)777.7765 C131:# 1&158
(619)777-7766
DESIGNERIENGINEER
C J A.ti ES .O. G YAit AM
33-163'CATW-DRAL CANYON DR.
USE OFPERMItj1NGLE FAMILY DWELLING
PATIVQ11 AT 01TV PA 01"M '7-!A-'7
QUTMTkRRA ^ TRACT 23913 PHASIS It
PLM 311
,
` FEE DESCRIPTION
FEES
TR&C't' CI�Si`Id.11t" t:IcJRI 2,349.00 SF
P6RC11/PAt'I0 49.00 SI~
CxA.RAGE(CARPORT 58780 SE
}
,
OSTIMATED COSH" OF CONSTRUCTION
140,250.60
PERMIT FEE SUMMARY
PLAN CHTWX, .FM, 101-000-439-315
CONSTRUCT[ON FEZ- 101-000-418-M $183.!10
NfECHAN]CAL FE, 13 101-000-423000 368.50
ELECTRICAL FEE 101-000420-060 $152.81
PLUAI4fNC2FUS 101-000-419-000 $174,!10
STONO NOTION Fad? - RESID 100-000-241-000 $14.03
GRADING FEC 10L-000-42340 $20.00 .
17*1ZAS T RUCTUREi 1 22.x-(100-443-,."142 S3,140.98
ART IN PUBLIC N ACES - WE= 701-000-255-000 $ l,t1 63
SUB -TOTAL CONSTRUC'119.1v AND PLAN CHECK
LESS PRE-PA10 FEES
$0,00
"TOT.kL 1PER.AW FEE .EIAT1± NOW
$5.113.89
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 9
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 6yr
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL A PROVALS
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 If rvily
Heater Final
Water Piping j v
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
Finan
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. I
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
I
Desert Sands Unified School District
„T �• 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated At 9-77C%_1Snn
CERTIFICATE OF COMPLIANCE
Date 1/3/96
No. 14003
APN # 604-263-021
Jurisdiction La Ouinta
Owner NameRoger Snellenberger & Associates
No, 79180 Street Nuevo Dr..
City La Quinta Zip 92253
Tract # 23913 Lot # °10.
T_vpe of Development Single Family Residence
I.on.ment's
Permit #
Log #
Study Area 233
Square Footage 2359
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 2,359 or $ 4,057.48
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed proiect may now be issued.
Fees Paid By Roger Snellenberger & Associates `' Tele0lone 777X7766
Name on the check
By Dolores A. Ballesteros d
Superintendent
Fee collected /exempted by Pauline Pearson
Payment Received r $4,057.48
(�
Check No. 10634
Signature Po_,��.Qv n. PV JAI A.1 /V-yN
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
cla Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Coov - Accounting