9601-015 (SFD)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. 488234 B 12/ 3/93
License # Uc. Class��
Date }_ —91& SignatureofContractort/ ( m
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 sectiWh' ' ` Yi' 466 completed if the permit valuatio6iih4or$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 tho��royisio f�
Date: /_ 1l _ !?h 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 resu f�f. this applicratiid agrees to, & shall, indemnify
& hold harmless the City ofvaa"e, Fts-'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.
•61g (Owner/A9ent) Date
ALC If. ,
., 13UIL ING PERMIT
� AI-% tir��_Ivx�
DATE R " "
VALUATION �' "'• `""`
LOT "`
TRACT
JOB SITE ADDRESS 79-2051,1',1'1C0 CJRC J,%,
APN _ 604-263-{)17
OWNER
CONTRACTOR
ONTftt?C"F13(Z. WELLE B t GER. & AS"S
ROOM
ROGER SNIELLENBER.GFR & ASS
41865 OARMN"AALI #212
41865 BOARDWALK #212
PALM D1 SER.T CA 9221.1
PALM DESERT CA. 922 VI
(619)777-7766 (` bui 1858
(019)777-7766
DESIGN
,!P%NaN.9Fb. LAND
'11ki : r..r, a e.11 zr: 4;=V* IN,-
33-1.63 •CAI71FDRAL Ca M"ON DR..
USE OF PERMIT "' '
CATBEDRAL CITY, CA.922NI770=1
QUIN'1`bJ(.KA. - `i'IKAU1' 2M)13 PHASE 11 I
PLAN 4
FEE DESCRIPTION
FEES
,,:i.'.1J ACrI' CONSTRUCTICF•td 2,713.00 51'
PORCH/PATIO "'00 Sl<
4ARAOUCARPOWr 596.00 Sl"
FSTUN1ATED C( a^"i OF CONSTRUCTION
163,968."
h'.F,R.MIT FRE SUMMARY
PLAN W Fr'F 101-M-430-318 $729.49
CONNS'1' VCTION rfy-1 101-000-418-000 5863.50
WCHANICAL FW, 101.000.421 -OW $89.50
ELECTRICAL FEE 101-000-420-060 $11.r2.83
PLU"INC FEE 101-000.419-000 SiM.00
r
3'1' No 41OT m m. - Rum 100-000-2,41-000 $16.40 `
GRADING L^M 10.1-000423-000 $20.00
1NFRAS'1Tk(JC1'URE PU, 225-000443-342 $3,662:97
ART iN P(17k3LIC PLACES - RESM 701-000-255-000 $159.92
sue -TOTAL CONSTRUCTION FIND PLAN CHECK .
$5,900:61 .
LESS PPLE-PAJD FEES
$0.00
{
Tt~;fAL PER1V1 ff FES DtT NOW
ss,"0.61
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 C
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing ZZCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
-77
Drywall - Int. Lath
I 4Z
Final
Final
BLOCKWAII 4PPROVALS
POOLS - SPAS
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
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
Final
Utility Notice (Gas)
ELECTRICAL ALS
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) Ed
COMMENTS:
Desert Sands Unified School District
R� .�•,.,,. 82-879 Highway 111
Document CannotBe Duplicated Indio, CA 92201
CERTIFICATE OF COMPLIANCE
Date 1/3/96
No. 13998
owner NameRoger Snellenberger & Associates
N,,: 79205 Street Latigo Cir.
APN # 604-263-017
Jurisdiction La Quinta
Permit #
Cog #
City La Quinta zip 92253 Study Arca 233
Tract # 23912 Lot # 14 Square Footage 2783
Type of Development Single Family Residence No. of Units 1
Comments
By
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 2,783 or $4,786.76
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 Telephones 777-'7766
Name on the check r
r °r'
Dolores A. Ballesteros
Superintendent rr,''• -
.
Fee collected /exempted by Pauline Pearson Payment Received - $4;786.76
Signature 2-L 4 , X UA,i o / D Al AA J6 L
Check No. 10634
pr 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