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LICENSED CONTRACTOR DECLARATION
I hereby 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. 458234 a 12/3/95
License # L ic. Class Exp. Date
'Date Signature of Contractor n _
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
WORKEWS 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 sectioTilrh eft of\W6 completed if the permit valuatioW16364400.00 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 pyovvisions
Qate: { 14 G Applicant F/"?
f((
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnity
& hold harmless the City ofilrSdif ak _eIIsbitjy fficers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if:
work is not commenced within 180 days from date of issuance of such
permit, or -cessation of wcrk for 180 days will subject permit to cancellation:
I Certify that I have read this application and state that the above information is
correct. 1 agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
DATE ar -1- IVALUATION LOT
JOB SITE ADDRESS 79_200 LAT,IC0 CIIFiCll✓E
OWNER
ROOER.SN'13 LLMTBERGER.&A.93
41 '`5 'I3f3zWWALK H212
PALM DESERT CA 92211.
(61,9)777-776
USE OF
PLANt Alt
FEE DESCRIPTI
PERMIT%0.-00$
TRACT
ROGWR SW IJIFNWIR.OFR & ASS
41865130ARONVALK 0212
PALM 13rSl:RT cyk 9,2211
`61.9)777-7766 C'SL# • 185R
OESIG (:rlAlIl ER
to,
OARLAM
33.163 CATHEDRAL CAW014 ISR.
CATHMRAL CITY', CA.92234 710-'
TRACT C0N:TfRUCTI0N 1.969-00 S
0ARAWCARPORT 5$3.0 .S1~'
1
LSTIMATED COST OF tC'ONS'TRUCTiON
PLAN QHTTGh M
101-000-439.318
S59503
C0NSIRUCTT.ON:itt273.
101-000.418-000
$706.100
11XCHANICAL rEC-
101-000-4421.000
S63A)
D.JECI'RICA.L M
101.000-420.000
5144.04
PLUMBING 1:•7-F,
101.-000-419-000
$1:50.00
STONc3 MOTION M", - RMID
100-000-241-000
$11.83
ORADINO
101.-000.4'$31000
$210,00
INFRAIMIUCIVRE fai
2 25-000-443-Uil
ARTAN1'UBLI09LA.CE?-RHSJV''141.1-000.255.
09
$28.22
SUB: TO'' AL CORSTRUC.°l'1ON AND PLAN CHECK
LESS PRE --PAID FEES
11181289.20
$4,385.53
$0.00
TC)` AL 11'EfMff: FEES Vi11r NOW I %,385.53..
y.
RECEIPT I DATE IBY DA'
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1, 049Ducts
Slab Grade
Return Air
Steel v
Combustion Air
Roof Deck 7 31 6'if
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
InsulationVents
Fireplace P.L.
Grills
Fireplace T.O. Z,
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall .
Exterior Lath
Drywall - Int. Lath Z Zo r 6/
Final
Final
POOLS - SPAS
BLOCKWALLIAPPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste Lines
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:
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 '
Final
Utility Notice (Perm)
Desert Sands !Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775_�500
CERTIFICATE OF COMPLIANCE
!Date 1/3/96
No. 13999
Owner NameRoger Snellenberger & Associates
No: 79200 , Street Latigo Cir.
City La Quinta
Tract # 23913 Lot # 15
APN # 604-263-016
Jurisdiction La Quinta
Zip 92253
Permit #
Log #
Study Arca 233
Square Footage 1968
Tvpe of Development Single Family Residence No. of Units 1
Cold!! eats
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 SnellenberQer & Associates
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature 1 e
Telephone ;777-7766
w
Payment Received $3,384.96
Check No. 10634
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