14882 (SFD)P.O. BOX 1504
Building78-495 CALLE TAMPICO
Address 48-0632 Calle Esperanza. LA QUINTA, CALIFORNIA 92253
Owner
Roger Snellenber er & Associates
Mailin
Address 41-865 Boardwalk 0212
City Zip Tel.
Palm Deserts 92221 1(619)777-7766
Contractor
'Same
Address.
No. 14882
BUILDING: TYPE CONST. VN OCC. GRP. R
A.P. Number 6146-121-026
Legal Description ' Lot 26 Tract 20052-4
Project Description SPDa Plan 4
Laguna De La Paz
State Lic. City
& Classif. $ 488234 Lic. # 1 g5gj Sq. Ft.
Arch.; Engr., • -
Size i
Designer CarlAs Elias ,,, Engineer I New ❑
19'8522.5Charlesiwortu Dr. TA1.9)328-7271
'�y
Zip State
C6thedral Cit , CA 92234 Lic. #
LICENSED CONTRACTOR'S DECLARATION
JI hereby affi m that I am licensed oder g visions,of Chapter 9.(commencing with Section
.y7000) of Dwis�on 3 of/ e�Busine/s>sd/P��ofe/ssion/��C and icense is in full force and.,
effect. 1 ci /X ar 5[d[ rt Ea� ^ a 7
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires. a
permft'to construct, after, improve, demolish, or repair any structure; prior to its Issuance also
requires the applicant for such Penn# 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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 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) pcensed pursuant to the Contractor's License Law.) -
O 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 o" Company
.CYCopy is filed with the city. O 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.)
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
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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,
j DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
I ATTORNEYS FEES.
This is a building permit when properly'filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
Mal II ng. Address
City, State, Zip
No. ',
Add.❑ Alter ❑
Estimated Valuation . ;93 , 715 . #30
. PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I. • , -
Grading
Driveway Enc.
infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ Demolition
AMOUNT
518.25
•512.50
612.00
127.25
150.00
9_37
20_00
.0
- /0
yy
,G 108.59
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear P ine
Side Street Setback fro me ine
Side Setback from Pry y Line
FINAL DATE I ' PECT
Issued by:
Validated bv:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES 1
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK ,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. p
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. I SO. FT.
TEMP. POLE
WALL SO. FT. ®
DRINKING FOUNTAIN
SO. FT.
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
l
WATER PIPING
NOTE: Not to be used as property tax valuation
\
FLOOR DRAIN
MECHANICAL FEES
ROOFING n
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE . DRYER
\
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN 11
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK ,
FORMS
SEWER' O t5
ROUGH WIRING
DUCT WORK
ROCK STORAGE
REINF.
VfFOUND.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
RADING
cu. yd.
$ plus • x$
=$
LUMBER GR.
FRAMING
ROOFING n
VENTILATION
V
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWA L
LATHING U
MESH
INSULATION/SOUND
it
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
/