9808-027 (SFD)LICENSED CONTRACTOR DECLARATION
U) ' I. hereby affirm under penalty of perjury that I am licensed under provisions of
' H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C'4,w Professionals Code, and my License is in full force and effect.
O=)M License # Lic. Class Exp. Date
� CY LOdaS23d1 1?.131/39
r`
O r-- ��te �rc1%�]_ Signature of Contractor - ; f Z
J V 0 OWNER -BUILDER DECLARATION
�.aW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
` Z_ ( ) 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
a sale (Sec. 7044, Business &. Professionals Code).
' ( ) I, as owner of the property; am exclusively contracting with licensed
' µ contractors to construct the project (Sec. 7044, Business & Professionals
Code).
t C O I am exempt under Section B&P.C. for this reason
LO
` N Date Signature of Owner
O; rn
CJ Q 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.
STATES FUND 626355.97
(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
Code, I shall forthwith comply with those provisions. F
+/bate: 1,44r Applicant--
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each'person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit.to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
ignature (Owner/Agent)
- BUILDING PERMIT'' ' -PERMIT# ti �' CONTROL#
r
DATE VALUATION 5162 9411.70 LOT 20 j' TRACT �4>
7 4 3 ®
t,
SITE
ADDRESS.f t�1 tZlA ti �Q!.�
APNJOB �fB�-d8Q4-11.3.1
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE r-,X.CF[/VNQf. Gk0UP
R0611i S�<'ELLFm rPGIEI• & ASSOC.
715-61-5 NAPLES Lill
7€ 615 NAPLES DIUVk.
LA QUIN`1'A CA SU253
LA QUIN'1'A CA 92:253
C'iF,q 1R59-1
f,,, •
USE OF PERMIT
SINGLE FAMILY M LLING
SFD. PLAN 6AR-N. LOT 20, PF.IWT DOES NU7' INC•LDE 'UBLOCK: y',•
WALLS OR POOL. PLAN CRECK ITFE- REIDUCEO 75°•'0.FOR MULT)i? X I r�
ISrSUAI C7, OF SAW! PLAN TYPE.
TRACT CONS-1RUC'IO.N 2,743.00 SI:'
P7RC-YPP%T1O 90.00 Sig
F. iAEtAt;l?JL'A1 PORT 598.00 SI.
ESM. I TED COSTO C'ONYMUC`'i`JION
- r
462194&70
.-PMMIT FEE SUMIktARY
CONSTRUCTION F'E-E 101-001,415-000 �K6t1.0fJ
Pt AN (11ECK rEE 101-000-434-31$ $179.67
;VITY714ANICAL FEE. 101.-000-421.000 S92.cx)
-
ELECr91C:AI. F03 101-OW420-000 5157.17
` KLAMB NG FEE 101-000419-00 5166.00
STRONG NIO'F'.TO- N FEE • _RFSID 101-000-7,41 -NO $16.29
(3RADING FEE 101-000-423-000 $20.00
INFRASTR1rC-I'M.tlttG" 265-a)0-443-342 $3.639.41
;.r
P"CISF PLAN 101-000.441-345 525.00
`
ART INPUBLIC PLACES - !WSID 7011-000-255•-000 5157.37
4,
91113-T0TA.t, CONS"T'R.Ui~TION ANF..) PLAN C.T- ICl.'
LESS PRE -PAID FEES
$0,00 t *'
TC)•i't91.0. PKIZMXT FILE -S DIIJI F NOW
—&5, 3;12.91
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
C
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
- -
Exhaust Fans
O.K to Wrap
�Z..Fj� 4 ��
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
ou
�-
Final
Final
POOLS - SPAS
BLOCKWALL
APPROV 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
-Z , 4
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
r
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
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 notintended or offered for
sale (Sec 7044 -Business & Professionals Code)
as owner of the'property; am• ezcluswely`contract'ing with' licensed
.Contractors to construct the project "(Sec.1044, 'Business & Professionals
Code).
(•) .I am, exempt under Section B&P.C. for this reason
' Date "` Signature of ' Owner.'
WORKER'S,COMPENSATION DECLARATION
1 hereby affirm under, penalty:of pequry;yone of the, following: declarations:
( )iI have:and.will•maintain a certificate ofconsent to self -insure for workers'
compensation; as` OroJiclecl "for by Section':3700 of, the. Labor Code, for the
performance of the'work for wtiich this permit is issued
O ,I have and wlil'',maintain.workers compensation�msurance, as required by. ,
Section 3700 of the” Labor Code, •for"the performance of the work for which this
Permit is issued.. fvly wdrkers 6omperisaiion insurance carrier& policy no. are:.,
Cartier.. , t. ;Policy No. ,
3''i w
STATE FUND ' , 626355-97
(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,
Ir shall -not employ, any person in„any manner so as to become subjectto the
workers' compensation laws of-California,..and agree that-,ifl•should°become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply with those provisions. ''•
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage, is unlawful and
Shall subject an. employer to ci:irninal:penalties and civil fines up to. $100 GOO, in
addition'to the cost of.compensation,`damages as provided for in Section 3706
of the Labor Code, interest anis attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fora 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 applicator 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 186 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
BUILDINGPERMIT PERM1T27 CONTRDL#
DATE VALUATION $162,948.70 LOT 20 TRACT 28�5� O
JOB SITE 6}679 PARMA COURT
APN 6094080-013
ADDRESS .
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE. EXCHANGE GROUP
ROGER SNELLENBERGER & ASSOC.
78-615 NAPLES DR
78615 NAPLES DRIVE
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)772-0222 CBL# 1858
USE OF PERMIT
SINGLE. FAMILY DWELLING
SED, PLAN,6AR I LOT 2D, PFRMITDOES. NOT INCLUDE BLOCK
WALLS OR POOI . PIAN CHECK FEE REDUCED 790/16FOR-MULTIPLE
ISSUANCE,OF;.SANZ PLAN TYPE-,
TRACT CONSTRUCTION 4,763 00,SF
PORCH/PATIO 90.00 SF
O'ARAWCARPORT 598.00 SF
TI
y, ESTIMATED COST OF CONSTRUCON
162,948.70
-PERMIT FEKSUMMARY `
CONSTRUCTION=FEE101-000-418-0S860:00
� �..
PLAN.CHECKFEE 10,1-000-439-318 �00
$179:67
MECHANICAL -FEE 101=000-421-000. 592,00
- ELECTRICAL FEE 101 20-01XI 5157:17
PLUMBING FEE;,. 101-000-4194M :5166.00
STRONG:MOTION FEE - RESID 101400-241400 $16.29.
GRADING FEE 101-000423=000 $20:00”
,
1O-RASTRUCTURE'FEE 223-000-!L43-342 53.639:41
PRECISE PLAN 10i -0U0-441-345 $25.00'
ART:IN PUBLIC PLACES - RESIC 701-000-255-000 $157.37
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,312.91
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$5,312.91
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR