9808-042 (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
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 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
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.
( ) 1 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:
Carer Policy No.
STATE FUND 626355-97
(This section need noebe 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.
Date: 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 inspection purposes.
Signature (Owner/Agent) Date
,oc'i,4.e
BPERMITq CONTROL#
BUILDING PERMIT 9808-04Z
DATE VALUATION 5141.248.40 LOT 6 TRACT 2114-1-4
JOB SITE 43760 VENICE DRIVE
APN 609.084-013
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)7724222 CBL# 1858
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD, PLAN 5A. LOT #6, PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOL. PLAN CHECK FEE REDUCED 75% FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
TRACT CONSTRUCTION 2400.00 SF
PORCH/PATIO 160.00 SF
OARAGEICARPORT 449.00 SF
ESTIMATED COST OF CONSTRUCTION
141,248.40
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $786.50
PLAN CHECK FEE 101-000-439-318 $161.98 .
MECHANICAL FEE 1014000421-000 $60.00
ELECTRICAL FEE 101-000-420-000 $141.48
PLUMBING FEB 101-000-419-000 $140.75
STRONG MOTION FEE - RESM 101-000-241-000 $14.12
GRADING FEE 101-000-423-000 $20.00
R RASSTRUCTURE FEE 225-000-443-342 $3,130.21
ART IN PUBLIC PLACES - RESIB 701-000-255-0 $103.12
SUB -TOTAL CONSTRUCTION AND PLAN ClIECK
$4,558.16
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
54,558.16
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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 13 12/31/99
,,Date k , ,f, t 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:
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 bq- Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(,411 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 y�J*{���.( FLM)
Policy No. tt l pp
l iM Z FLM) 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.
Date: o : + r 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 inspection purposes.
/Signature (Owner/Agent) _ j J) E���A-Date -F
PERMIT# CONTROL#
BUILDING PERMIT
DATE VALUATION $141�2,48.4f) LOT, � TRACT �L.. ,,,
4-14
_�....� A
JOB ADDRESSINI i Dfr IV E
APN 60-090-013
OWNER
EN�iGIrpNfE. E.1R
CONTRACTOR DESIGVtiNEy1R,,
rIIE VCenN.E VWJJ ;..• •. -,
[r/.
7$-615 N.NPLES DR
78615 NAPLES DRIVE.
LAQTJI ; A CA 922.53
LA (,1ANTA CA 92253
)772-0222 C,1, ! $S$
USE OF PERMIT
S1N<a"LE' FAivatL DWELLING`
SM. 11LAN 1A, 1,0-1#6, P"►s"E2i1 't`i OBS NOT INCLUDE .t'LOCK WALLS
OR 1?OO. 1. PLAN (WkK kT-E REDUCED 75"fo FOR M3-rt.`CA"LE ISSUANCE OF
3AA*.PLAN 'I VPE. r)A`J�� + ��
TRACT C4:NSTEUCt`ION 2.,400,00 SF"
Poaca PAT16 .260.130 SF
(3ARAGI:A'A.W>0RT 449.00 Sri
ATELD 4Ja.MS SIR' CVA�IS IC�Vli...6 da..Jib
1Mf.B.�R.WCA•�ii
�'p p�{a� -�• �1'{, ,i�'y'y' �q;� 'pB.aA'i•1'Q�
X. Ife Y,i.LWN�l Slkl'J?,7 R/.�H.l4�l�d�.}t .
CMS'i UC'TION.T*EE 101-00041.8-M)
P? AN CE CtC F ER, 10)404,19-318 S:t?c 5.48
MUCHAMCAL tM 101-000-42;-131)0 $60.00
MEMfC%L FEE 10,1-CiOt'i-42"00 $141.48
PL'OW31NO Fr- E $3.40.71
k" 1'TtO14oMO?'iCiNME,,- XIESID 101-000-241-100 $T4A2,
MAD= FIM 101. -NO -123-0510 $'123.00
.WR A.STRUC'2'Mr.1,',l`:E 225.000-443-:342_ $;3.00,21
F1RT t,N .PUB..L IC PLA.O ES - RESH'o 701 -000 -?55-001#
sup-•��� At� c�JN�°r.�.T.scprr.�N .err€� Pi A,tdCz��c��c
$:�,�s�: xg �-
LESS PRE—PAID MES
$0.00 '
T3`)TAT, PERMIIf FE&S Dd1'Fl:jVV
54,5M.1�
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
y jo Q
Exhaust Fans
O.K to Wrap
2 _
F.A.U.
Framing
Compressor
Insolation
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
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/D—/ —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
d — •-
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
t
Final
Utilly Notice (Perm) �7/