9601-008 (SFD)r LICENSED CONTRACTOR DECLARATION
I hereky affirm 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. 4M234 13 1.2/ 3/95
License # Lic. Class AV.Date
!bate y Signatureof Contractor �— z ,„ ,
OWNER -BUILDER DECLARATION
I hereby affirm 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.
( ) I 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.
(this secton16ee_'dirio0e completed if the permit valuatioi%j$�fl> j$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 provlslons of Section 3700 of the Labor
Code, I shall forthwith comply with ", pf3,visiojIs i,
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 iof this application agrees to, & shall, indemnify
& hold harmless the City of-lnd{ar�lLehOits 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.
ALCM _
BUILDING PERMIT
PERMIT�T�
DATE 7t J
VALUATION f4-0 • LOT
TRACT -y 10
JOB SITE ADDRESS 7q l&; LATI(;o CIR LI:
APN 6414463-419
OWNER
CONTRACTOR \ -
ROGER SN.EU,E1Q1 R.GER &.SASS
ROGER SNEL;LEN.BERGER & ASS
41865 i3OARDWA X #212
41863 BOAit.1;)WALK #212
PALs11 DESERT CA 92211
PALM DES -EXT CA. 92211
(61�)777-7706 C1iL# 1858
(619)771-7766
DESIGNERIENGINEER
CHARI.B.S D. GARLAND
33-163 CA.T11MRAL CANYON DR.
USE OF PERMIt41V1r 1 N dY .r l UVW,i ;, ,. %u
CA'1"t=1 DRAL CITY. CA 922.34 7711-7
Qi:7INIMPLA. • 'rRA.Cr 23,913 P -HASH 11
PLAN 1,R
FEE DESCRIPTION
FEES
MACE CO;f STRUCI'10N .1. .00 SIF
OARAGMARPOWf 553.00 SF
USTA'MATM COST Or, CONSTRUCTION
118,289.20
jPERNIlff F EX SlfMlA7ARY
PLAN C kIFC;K FTX 101-000439-318 $595.43
Ce'INIS.tRUC.tTON ME 101-000418.000 $706.00
1�ir.:;MAN1C°AL ME 10.1 -000 -42t -WO W.50,
i LYXTRICAL FFf~ 101-000420.000 $144.04
PLt1MB1NO FFE 101. -0(M) -419-0(1C1 $15n,00
ST: NC, MOTION ) - U SIM 10()-000-241-000 $1.1.83
GitANNO FW $20.00
11N�'12A.S'i'Ri3c TURM .1�k� `3,25-000-443-342 52,661.51.
AFT 114 P(MLIC P3,AE''F!5 - RE,115 70t-000.255-0[.)0 $29.22
SUB-TarAL CONS'IRUMON AND P1.,A.N CHECK.
$4,385.53
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DIX, NONY
54,115.53
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 16f d
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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
Drywall - Int. Lath
Lot
Final
Final
POOLS - SPAS
BLOCKWALL APAROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans rO.K.
for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
IN G, ice:
Document Cannot Be Duplicated
Date 1/3/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
CERTIFICATE OF COMPLIANCE
No. 14006 _ Jurisdiction
Owner NameRoger Snellenberger & Associates
No. 79185 Street Latigo Cir.
Citv La Quinta _ Zip 92253
Tract # 23913 Lot # 12
Tvpe of Development ' Single Family Residence
Comments
It
APN # 604-263-019
La Quinta
Permit #
Log #
Study Area 233
Square Footage 1968
No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 X 1,968 or $3,384:96
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 Roger Snellenberger & Associates Telephone 777-7766
Name on the check
By Dolores A. Ballesteros
Superintendent r.
Fee collected /exempted by Pauline Pearson Payment Received $3,384.96
Check No. 10634
,Signature 1"L, _(�AAA 8y>^
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