15303 (PAT)44
P.O. BOX 1504 No. 1530'3.
Building 78-495 CALLE TAMPICO
Address 48-511 Via Amistad LA QUINTA, CALIFORNIA 92253
Owner
Gordon Cologne
kfailing BUILDING: TYPE CONST. OCC. GRP.
;Aeidress S aMe as above A.P. Number
City Zip . Tel.
La Quinta 92253 Legal Description
Contractor 3$'Q, Sq s Vt. open
Project Description .
Sti'Enl1eb
.AddresLattice Patio Cove : .
s .
59-150 moon Ranch Road
CityZip
.H. 22243.-'8917 329--7261
& Classif. ,. I Lic. #
' Arch., Engr.,'
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm hat I am ! tensed undo/provisions of Chapter 9 (commencing with/Sectlon
7000) of.Divi 3 of the 3,Usiness and rofessions Code, and my license is in full force a_ d
effect. ` cs
r
SIGNATUREI DATE
OW�R• UILDER DECLARATION
I hereby affirm that t am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Coder Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is - exempt therefrom, and the basis
./or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a chill penalty o/ not more than rive hundred dollars ($500).
O 1, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the building
or Improvement is sold within one year o/ completion, the owner -builder will have the burden
o/ proving that he did not build or improve for the purpose o/ sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and .Professions Code: " The Contractor's License -Law
does not apply to an, owner of property who builds or improves thereon, and who contracts for
such projects with'a contractor(s) /!tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
. WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
Policy No. Company
. ❑ Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
or less.) f /r
I certify that in the performanceFof thg work for which this permit is issued, I shall not
employ any pperson in any manner,s6 as to become subject to ?he Workers' Compensation
Laws of C �i.lyif,,o�nia
---r-ttaV'�•Owner "0''�/
NOTICE TTAPPLICANT. If, after making this Certificate of Exe n you should become
subject to the Workers' Compensation provisions- of the Lra`r Code, you must forthwith
comply with such provisions or this permit shall be deemed r p)-Kred.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days:
I certify that I have read this. application and state that, the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
,Mailing Address
City, State, Zip
Sq. Ft.
Size
NeWRO
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑
-Demolition Ci
S.M.I.
Grading
Driveway Enc.
Infrastructure .
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center
Rear Setback from Rear Pr
Side Street Setback from
Side Setback from Prop
FINAL DATE
Issued by: I
Validated by:
Validation:
�fr Line
innne C
in�
'%A.
I
Estimated Valuation $ 5454.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
52.65
Const.
$ 3�
Mech.
Electrical
S.M.I.
Grading
Driveway Enc.
Infrastructure .
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center
Rear Setback from Rear Pr
Side Street Setback from
Side Setback from Prop
FINAL DATE
Issued by: I
Validated by:
Validation:
�fr Line
innne C
in�
'%A.
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. • SQ. FT.
'HEATING (ROUGH) '
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE '
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SQ. FT. ®
I
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ . plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. H TER OUTPUT, B.T.U.
SQ. FT. RESID a 1 V< c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEETM�.FEEPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR _
SETBACK
GROUND PLUMBING
UNDERGROUND'
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
'HEATING (ROUGH) '
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE '
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ . plus x$
_$
LUMBER GR.
FINAL INSP. _
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 8/2/93 1 Type of Permit La Quinta
No. 112355 Permit #
Log
Owner Name Roger Snellenberger & Associates
No. Street See Below
city La Quinta Zip 92253 Study Area 109
APN # I Tract # I Lot # 0 Square Footage 15
Type of Development Single Family Residence No. of units
Comments 48-517,48-515.48-513;48 511;48-509 Via Amistad - Total 9.480 sq ft
At the present time, the Desert Sands Unified School District does not collect fees on
garages/ carports, covered patios/ walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying .school fees at this time due to the "
following reason:
i
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount of 628.00 x 0 or $ 3,140.00 have been paid to D.S.U.S.D for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Cashier's Check/Roger Snellenberger Telephone 777-7767
Name on the check
BY James E. I'.ivPly
Assistant Superintendent, Business Services
Fee collected/exempted by Tomi Doebereiner
Payment Received
Signature, Check No.. 055336
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Collector. Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting