9808-021 (SFD)LICENSED CO
TOR DECLARATION
'� I hereby affirm under penalty of perjury that I am licensed under provisions of
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c14 w Professionals Code, and my License is in full force and effect.
CO ch License # ' Lic. Class Exp. Date
LO 465234 B 12r'31/99
W v�
' Z'� "Date ��`10/l Signature of Contractor /lr�,,zy-
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 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
perfor , ance of the work for which this permit is issued.
(toy I 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.
STATE FLUD .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.
abate: (El" 2120 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 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
o'r inspectio/n�, purposes.
Signature (Owner/Agent) _% o , L¢'��c % /L d� D'ate
' BUILDING PERMIT � - PERMZ#�". � -�� �' . °°NTR°`#
91409.4)2.1
�sIq'//(( .- .
DATE �!"P1 VALUATION S1.41,2490 LOT 1;Z TRACT
f
.
JOB SITE r e
ADDRESS b3 -T 6:541 �: AR1iMWOR
APN �►9'P9-flilfl-0113
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE f-,'X-C1A.APIGF GROUP
RCZGUM SNE LLENIF3f'.1?.,G:i, R & ASSOC.
7"15 NAPLES DR
78615 NAPLES DRIVE
LA Q1AN`f'A CA 92251
LA QUfNTA CA. 92253
('17601IM-0222 C13I.. ` 1.858
1 1
USE OF PERMIT' f
SINGLE FAMILY DWELLING
Ij
S:FD, FLAN 5.33, LOT #14, PERMIT DC AR8 NOT 1NCLU7DE BLOCK WALLS
1'J
t•
i
TRACT CONSTRUCTION Z400,00 SF
p4
,
PORCHr1PATl0 11410.00 SP
GiV.2AGEICA RT 449.00 SF
'
r�,S MTIED Q.'M OF CONI S i UC- ION
-141,243.40 '
PEI RMIT FEE S4JMItf4ARY
CONSTRUCTION FEE 101-000-418440
PLAN C" f LECK FEE, 101-000-439-315 S0,547.91
1V KTIAN1C'AI, k P,13 101-000-.421-0030 $0.00
1~:T.FMIC:AL E 101-000-420-Ofi(i $141.48
i'T..LTMBING FEEE 101-000-41 -0(10 $140.75
14,12
STRONG N10, TION FEE - RESID 101-000-2411-00 $14,
f� 11/1 Ap1�1
Q'RA1 ING FTX- 13J.1.-1✓'J+J'^l�G.' -WO
I..N—FI ASTRUL+i'U.f2.E F';Ei3 22.5-000-443-3402 53.430.21.
ART IN PLRLICTILAC'ES - RFSIC 701-000-25,5._ 00 5303.12
,:!.;R_'t r,T•��r, 4: oNscu..frrrca�r AND PLAN Ci 1H(K.
$5,04`1.09
USS PRE -PAID FEES
som
ri?,*RiNur F IFF -6 DDC NONV
$5,044.09 .
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs0_
Forms & Footings
GG .Q
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_/d•-
/,Q - .7- Q _-
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
i
Drywall - Int. Lath
/
Final
Final 4
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
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
Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
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 Contractors
License Law for the following reason:
( ) I, asowner 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).
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:
O 1-haveland will.maintain.a certificate of consent to self -insure, for workers'
compensation,,as provided, for by Section 37cd.bf.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 forthe`performance'of the:work for,.which.this
permit is issued:,M'y,workers' compensation`: insurance carrier & policy no..are:
Carrier Policy No.
STATE FUND. 62633347
(This section need•not be completed'if the permit valuation Is for -$1 00.00 or less).
O I certify that in the performance of the. work for which this permit is.issued,.
["shall not employ any person -in any, maner so manner become subject to. the
workers' compensation laws of�CAI ifornia, and agree that if.l-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 criminal penalties anis civil fines•up.to $100,000, in
additionlo 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 1he building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection_purposes.
Signature (Owner/Agent) Date
19:'iL1r
--
CONTROL#
BUILDING PERMIT PERMIT 980"1
-
DATE VALUATION x141A4&40 LOT 14 TRACT 2q5`B 7
1
JOB SITE
ADDRESS 41450 PARMA COURT
1'APN 609-080-013
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE EXCHANGE GROUP
ROGER SNELLENBERGER 81: 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
SFD, PLAN 5B, LOT #14. POMT DOES NOT INCLUDE BLOCK WALLS
OR POOL. _
TRACT CONSTRUCTION 2.400:00 SF
PORCH/PATIO 160:00 SF
OARAGWCARPORT 449.00. SF
STIMATED,COST OF-CUNSTRUCI'ION
141,M40
PERMIT FEE SUMMARY
CONSTRUCTION.FEE 101-000-418=000 $786.30
PLAN'CHECK•FEE,.. 1014X0-439-318 5647:91
MliCHANICAI FIsTs 101-000.421-000`... $60.00
FLEgRICAL FEE ,101=000-420-000 $141:48
PLUMBING FEE 1014X)0-.4194000 $140.75
STRONG MOTION FEE = RESID 101400-241-000 '414.12
GRADING FEE 101=000.423=000 520,00,
INFRASTRUCTURE FEE225,-000-443=342 $3,130.21
ART IN PUBLIC PLACES - RESIC 701.000-255.000 5103.12
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,044.09
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
55,044.09
RECEIPT
DATE
BY,
DATE FINALED
INSPECTOR