9808-022 (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
498234 F3 12/31199
.914ate 0/0 hn, 2! 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 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
pVtion
ance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
S3700 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.
`rA!I'E 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
C de, I shall forthwith comply with those provisions.
6Wate:/7- A/Cipplicant,•,TA?=?—°1�`
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) `-''f -� i�d°.dA Date ?Zl t!
BUILDING PERMIT PERMIT�#1t--^^^"'^r�• CONTROL'#
DATE VALUATION .�� �53.S4i LOT 15 TRACT 2
y�9-
JOB SITE -Q>E1_ki,1�9�1_i4J�tK.t
ADDRESS
APN
OWNER
CONTRACTOR /DESIGNER /EENGINEER
THC El�N1iGE fROUP
C.
R.(.X'11?R ♦Nr11A.GNjBI;:GtrR ASSOC.
78-60 NA:6'LrS DE.
8615 NAPE ES DiUVE
LA Q FIWI'A CA 92253
LA QUf.N"i'A CA 92IS3
f7hAl7'��-i�x?1? CLi{.» I�58
USE OF PERMIT
SNI GLE FAMUP" F WELLING`A
t i3 1
SrD• PL 14 3A. LOT x#15 PERMIT OOLS NOT WCLLM BLOCK WALLS
0111111001.1. c
T1bkC T CUN1 TR.Ui` "C101'3 2.025.00 SF
PORCH/PATIO 5.^.00 SF
CJA1CA,G#JCAR >0RT 439.00 SE
FIMA ED COST OF CONISTRUCTION
t 19,2s3. 4i
PERMIT FEE SUMMARY
CONSTiBUC 1'1014 FEE 101 -ON -418-000 $709.50
PIAN CHF:C.K. FIX 101-000-43e9-31.8 Vqt 7.4N)
INIEC11ANICAL M-3 101-000-4211-000 $53.50
ELECTRICAL F UE 10.1 -000420 -NO 5128.16
PI'LJM INO FEE 101-0U0-41.9-000 $140.75
WRONO MOTION ME- .RESID 10! 4100-24)-000 $.11 93
(3RADIING FEE 101-000-423.000 4020.00
MRA,STRUCPURE FEE 225-000-443-342 $2,667.64
A10' fN PUBLIC PLACES - RESI.t: 701.-000-255-006 $48.113
SUB-TC)TAL CONSIRI.ICTI.ON AND PJ.,f1N CHECX
LESS .PRI;'-PALD FEES
WOO
TOI'Al." PP I..IN41T F f FS .i IJE NOVV
$4,367.51
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
-
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
!v 4iY
Compressor
Insulation
ez,Q _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
_
APPROVA S
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
—Z—
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:
3/97
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
t
Final -
- Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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. th'e'awork,: and the structure is not intended oroffered for
sale (Sec, 7044„Business & Prof essionals;Code). .
(') f; as owner of the property, am . exclusively.: contracting: with licensed
contractors to
"';' onstructthe' project. (Sec. 7044, Business &:Professionals
Code).
lam exempt, under Section: B&. RC. 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 forwhich.this permit is issued
O I have. and will ,maintain workers compensation insurance as'required _by
Section 3700'.of. the Labor Code;. for the. performance of fhe work•for`which this
permit is, issued. My workers' compensation, insurance carrier 8 policy; no. are:
Carver Eoljcy: No.
STATE FUND :626355'. ,
(This section need not be completed if the permltvaluation Is for $106.00 -or less).'
O `I`certity that in the performance of- he work'for which:this permit is issued,
,I*shall not employ1. any person in any manner -so as tc'become sutijectto 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 coniplywith those provisions.
Date: Applicant
Warning: Failure, to secure Workers' Compensation coverage is unlawful and .
shalhsubject an employer,to cnminai_penaities and civil,fines up to p00,00o, in
addition, to the cost of,compensation, damages as provided forin-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 pe�mitissue'i as a result of this applicaton agrees to, & shall, indemnify
& hoid.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
BUILDINGPERMIT PERMIT�OZZ - . CONTROLp
DATE VALUATION $119,ZS M LOT 15 TRACT 2S� Q 8
V
JOB SITE 4"20 PARMA COURT
APN 609.Ogg 4�13�J
.
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THE EXCHANGRGROUP
ROGER SNELLENB.ERGER & ASSOC.
78.615 NAPLES DR
78615 NAPLES DRIVE
LA QUINTA CA 92253
LA.QUINTA CA 92253
(760)772.0222 CBL#: 1858
USE OF PERMIT .
SINGLEYAMILY DWELLING
PFD, PLAN 3A, -LOT # 15. ,PERMIT ,DOES NOT INCLUDE BLOCK WALLS
OR POOL.
TRAIL CONSTRUCTION 2,025.00 SF
PORCH/PATIO;... 52.00 PF
'GARAOFJCARPORT 439.00'SF
1
ESTIMATED COST OF CONSTRUCTION
119253.50'
PERMIT FEE SUMMARY
CONSTRUCTION,FES 101=000418-000 3709.50
PLAN CIitECK FEB : 101-000-439418. 5587.90
MECHANICAL FEE 101-.000-.421=000 353.50
ELECTRICAL FEE : 101-000-420.000 S 128.16
PLUMBING FEE 101-000-419-000 $140.75
STRONGIMOTION FEE - RES1D ;101-000-241'-000 511.93.
`GRADING FFE 101-000-423-000 $20.00
INFRAPTRUCTU_ RE FEE. 225x000=443-342 32,667.64
ART INPUBLIC PLACES - REPII; 701-000-255=000 348:13
SUBTOTAL CONSTRUCTION AND PLAN CHECK
$4,367.51
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$4,367.51
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR