9808-026 (SFD)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
48823.1 B 17/31199
,,Date ';?/ 01• � Signature of Contractor • • �) - % >'ti
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
performance of the work for which this permit is issued.
(.,)4 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.
STAC`L FUND 625355••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. n
,,Afate:(-II,,� Applicant e f��,n%wT�
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.
, gnature .(Owner/Agent): Jl G'j�i,� Qate 6/
r BUILDING' -PERMIT PERMI q# r , , CONTROL# '
VALUATION$141.,248.40 LOT 19 TRACT • „�� {
DATEFAl"
,`
JOB SITE �SR3y�r
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TIRE FV"HANCx1= GROUP
aSci01C:;.
78-61; NJU)LES DR
78615 NAPLES DRIVE
LA OU1917A. CA, 92253
LA QU1�V`i'A t"A 92253
(760)772 -0 -WA CM -4 1858
+
USE OF PERMITS
—IN WELLING
-
.%FD, IVLAN SAR, LOT # 19, PIrRWT DOES NOT INCLI2DE BLOCK
WALLS OR POOL. PLAN CHECK FIX itF"sOUCIED 7s% FOR &01,11PLE'I
ISSUANCE OF SAME PLAIaInTE. _5
'MI.0-r CG14STiRC.k, i'10N 2400.00 SF
PiORCI-t/PATIO 160.00 SF
'
G.PXRA0FJk:AEtF'C)Xr 449.00 .51:
r
ESTINI rED COST OF C'ONSTRUC."n0N
141.:248,40 '
PERMIT EEE S>ff1Vi'li9fiRV
CONSTRUC 1ON FEE 101-000-418-000 $796.50
PLAN CHECK FEE 101-000-•4:39-? 1 R $lie 1.9N
NTC/--JJVQCAL FEE 10.1-000-421.000 560.00
'
0E:7FUCAL I- E 101-M 42"00 $141.48
P tllIHING n -,E 101-000-419-000 $140.75
$TRONA MIOT10'14 FIT, - RUSTP 101-000-24.1-000 314.12
.
CiItADNG rEle 101-000-423-000 S2fi.00
�,
NFRAS T RUC"TE J R r, P471, 265-000-443•-342 $3,130.21
'
A_RT Ila Pi.FFIL1C PLAC117S - RESW 701-000-255-00U $1C►3.!2
'
1 r`
SUB -TM, A11. CONtil"RUC710N AND PLAN CHECK
$4,558.76 -
LESS PRE -PAID FEES
10.00
�
TOT'A9.. P1+',f1LMI ff d ICES'DL►F, NOW
S4,,%5.1.16' t' "•
RECEIPT
DATE
BY
DATE FINALED
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 +
O.K. to Wrap
�L Z- 8 _
12-
Exhaust Fans
F.A.U.
Framing
L 2 _�
Compressor
Insulation
Vents
Fireplace P.L.
I
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Finalz
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
;.L- f
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
99
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Wain Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp: Use of Power
L
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:
O I, as owner. of Ahe=property,. or my .employees with wages as their sole
compensation, will do the.work, and the structure isnot intended or offered for
sale,(5ed. 7,044,,Business &:Professionals.Code)>
( ) I, as owner of the property,, am exclusively contracting with licensed
contractors to construct ahe, project={Sec..7044, Business & 'Professionals
code).
O 1 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:
( )':l.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 permii.t is issued .r
( ) I' have and will , maintain workers "compensation" insurance, as required'by '
<: ;•
Section 3700 of the Labor Code; foi ;jhe performance of the work for which. this•
'`permit is issued:;.M '46o vers' compensation insurance carrier & policy"no: are: `r
Carrier " Policy -No
STATE FUND
:(This section need not be -completed if the permit valuation is•for.$100.00 or less).
O i'certify tfiat in the performanceW the work. for Ni hich this permit is issued,
shall not'employ any person in any manner so'as to become: subject to the
workers' compensation. laws of Califo-miA,. and! agree that if '1 should become
subject to the, workers' •compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply with those provisiohs.
ba, te: Applicant;
Warning: Failure tosecure Workers' Compensation coverage is- unlawful and
:,shaii,subject an employer to crirninal'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 apokaton 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.
Signature (Owner/Agent) Date
ALAE
BUILDINGPERMIT PERMIT /1 "26 CONTROL#
DATE VALUATION 5141.248.40 LOT 19 TRACT 295-0 2
L
JOB SITE 43-649•PARMA COURT
APN 604-080-0113
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE EXCHANGE GROUP
ROGER SNELLENBERGER 6t ASSOC.
78-615 NAPLES DR
78615^9APLES DRIVE
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)772-0222 CSI.# 1858
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD.PLAN 5AR;- LOT, .# 19.ti 1 PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL ' PLAN CHECK FEE`REDUCEp 79% FOR MULTIPLE
ISSUANCE OF SAME PLAN TYPE.'
TRACT CONSTRUCTION 2.40000 SF
PORCSPATIO 160:00 -SF
OARA(MCARPORT 449.00 SF
F.STDNATED C09T OF CONSTRUCTION
.141,248.40
•PERMIT,FEE SUMMARY
CONSTRUCTION.FEE 101-000-418-000, .,• $786.30
PLAN CHECK FEE 1014000-439-318; $161.98
MECHANICAL FEE 101-000421-000 $60.00
ELEC'T'RICAL FEE, 101400-42Q=000 " :5141;48
PLUMBINGFEEs 101-000419-000 $140.75
STRONG MOTION FEE - RESID. 101"-000-241-000 S1412,
GRADING FEE 101-000-`423-000 $20.00 -
1NF'RASTRUCI'[JRE FEE 225-000=443-342 53330.21
ART IN PUBLIC PLACES, = RESIC 701=000-25$-000 5103:12
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
54.558.16
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$4,558.16
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r4�x`