9808-020 (SFD)LICENSED CONTRACTOR DECLARATION f
I hereby affirm under penalty of perjury 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. {,
License # Lic. Class Exp. Date
438234 B 17.1�1i�i9
/ate gill) ' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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'bf the' property, am exclusively contracting with licensed
contractors to.. cohstruct-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 hepby 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
perfor ance of the work,for which this permit is issued.
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:
Gainer Policy No.
S'i"A:1'E ruND 626_3.55-97
(This section need not be completed if the permit valuation is for $100.00 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
Cgode, I shall forthwith comply with those provisions.
Date: it IJ I/ J Applicant sf ir�rd� -J 2) .
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, 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 inspection purposes.
13ignature (Owner/Agent)
y PERMIT# CONTROL#
'BUILDING PERMIT +3td1Jf;-Q;t2ok
/!�
DATE gfVALUATION '062.94200 LOT ; TRACT . '2744-2
JOB SITE ,(4.;:+6—_ 9i �'.4.I A t0tlR.�..a �
ADDRESS A° Fi
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER ;
'1111: EXCHANGE GROUP
R.0 -GER SNEUENBF,FtGER & ASSOC.
78-615 NAPLES Celt
7861514APL.ES DRJVE
LA QUIN•1'A. CA 92.253
LA QUINTA CA 92233
(760)772-()222 C 11. 19.58
USE OF PERMIT
.S'Cl G F'A1b1ILYDWELLING
SI=D. PLAN 6B -N*. LOT ii 13. PERMIT DO S NOT INCi,ME BLOCK i
WALLS OR POOL. �
TiZ,P.C."i' C0143'1'iZUCI'ION `i,70.00 SF
Pokcur rio 90.0) &F
+� j
(JARAGWCAW1010' 5980) SF
I+„5'€'.€MATED COST OF C011TYMIXfION
t
162;948.70
PERMIT FEE SUMMARY
CONSTR(JCl 10N 1 -,V -E 101-000-418-000 $,l -6.00
LAN CHECK �T_3E 10.1 -000439-318 $71R.E9
NIECRA141C:AL 1-11, 10.1-000-421.000 192.00
EIECT RX AL. FEL 101-030-420-000 $157.17
PLLfW!3fN0 FE 101-000-419-000 $166.00
STRONO .M'OTIC N .FFE - R'(F,8M 1.01-000-241-000 $16.^9
• ; ' . .
GRADING Frrlr 101-000-423-000 $20.00
1Nr-RA3T_1 UCTUR , FF..E 225-000-443-342 53,639.41
PRE -CASE PLAN 101-OW441-345 $25.00
ART I'NP1J131.•10 p1.ACES =121 9JC 7(11-00(1 ?55-0(?0 $1.47.37
SUB -TOTAL Ca3N`TRU(-"I"lON AND PLAN CHECK
X5,851,93
LESS PRE -PAID FEES
$0,00
I'MjkL PERMIT Iit8+:F.S DUE NON'tr
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_//2
Underground Ducts
Forms & Footings
z
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
lk 7_� y ,�
F.A.U.
Framing
Compressor
Insulation
l-�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
rywall - Int. Lath
_
Final
Final
POOLS - SPAS
BLOCKWALL A:PPROW,LS
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
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
Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury 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,
License # Lic. Class Exp. Date
488234 B 12/31/99
Date Signature of Contractor
OWNER -BUILDER DECLARATION
hereby affirm under penalty of'perjury 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, _ae owner,of the- property,;<am exclusryely` 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
pert"ormance of the;work.forwhicfi•this permitis issued.
( ) f have and will maintain workers. compensation' insurance, as required by
Section '3700.of the: Labor Code, for the performance,of the work for,whichl this .
permit is issued.'My workerscompensationJnsurancq, carrier'& policy no: are:
. Policy No
STATE FUND _
626355-97'
(This section need not be completed,. if the permit valuation Is for. $1 00.00 or=less).
'( ): I certify•Ui`at iri the performance of the work for which this;permit•is issued,
1 shall not emp°loyany person in any manner so as,. to becomesubject to the
workers' coir peosatlon laws of California, and agree .that if I. should become
subject to the workers' cornpensation provisions of Section 3700 of the.Labor
Code, l shall forthwith comply.with those provisions.
Date: Applicant
"_Warnirig:. Failure to secure; Workers' Compensation'coverage is unlawful and
.`Sfii ll`subjectan employer to criminal penalties and civil fines up to $100-;000, in
addition to the cost of compensation; damages as provided for in•Seotion 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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, 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 inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT 80"20 CONTROL#
A—
DATE VALUATION S162,94&7O LOT 13 TRACT
JOB SITE43-680 PARMA COURT
ADDRESS
APN
6494080-013
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE EXCHANGE GROUP
ROGER SNELLENBERGER 8c ASSOC.
78-613 NAPLES DR
78615NAPLES DRIVE
LA-QUINTA CA 92253
LA QUINTA CA 92253
•
(760)772-0222 CBL4 1858
USE'OF PERMIT.
' SINGLE TAMILY -DWELLING
SFD,°PLAN 6B -N; LOT X13,:PERMIT D"OES°NOT INCLUDE BLOCK
WALLS OR POOL.
TRACT CONSTRUCTION' .. 2,763,00'SF:
PORC"-ATIO 90:OO: SF`
OARAGF/CARPORT 598:00 SF
ESTIMATED COST OF'CONSTRUCTION
162,948.70 ; -
PERMIT.FEE SUMMARY -,
CONSTRUCTION FEE - 101400-418-000. 5860:00
PLAN CHECK FEE' " . ' 101=000=439-318 1718.69
MECHANICAL FEE 101-000=421,000. $92:00
.ELEEC'1'RICAL FEE 101-000-420.000 $15717 '
PLUMBING FEE. 101..-000-419-,= $166.00
STRONG MOTION FEE - RESID 101 -000 -241 -OW $16.29♦
GRADING FEE 101-000.423-000 520:00
INFRASTRUCTURE FEE . -225-0004443=342 53,639.41
PRECISE PLAN 101-000-441-345. $25.00;
ART IN PUBLIC PLACES - RESiI; 701-000-255-000 $157.37
SUB -T rAL CONSTRUCTION AND PLAN CHECK
$5,851;93
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
55.851.93
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR