9601-014 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
C:) ^ Q co License is in full force and effect. !N234 B 12/ 3/95
n W License # Lic. Class D e
r --
Z � f Date ! / C� Signature of Contractor !% 0 .
(0 0r`
M OWNER -BUILDER DECLARATION
J W I hereby affirm that I am exempt from the Contractor's License Law for the
0- following reason:
(A () I, as owner of the property, or my employees with wages as their sole
Z 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
co Date Signature of Owner
LO
N
rn WORKER'S COMPENSATION DECLARATION
Q I hereby affirm under penalty of perjury one of the following declarations:
C) g Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
Lo HO cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL. performance of the work for which this permit is issued.
O J J () I have and will maintain workers' compensation insurance, as required by
M Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL LO Carrier Policy No.
_Z (This sectjQp1ngpclfrtq,t � completed if the permit valuMcgn§°ig5$100.00 or less).
r- o () I certify that in the performance of the work for which this permit is issued,
C3 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
e
-Code, I shall forthwith comply with 1�.qseJ•royision�� n
/Date: ,r// _Applicant 1
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 3708
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 of4ispplication agrees to, &shall, indemnify
& hold harmless the City ofcl Ila/its"ificers, 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
7�7
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.
'ASignature (Owner/Agent)_T/ �6 ? Date) 14-7
"`C"I
..,.,"BUILDING
PERMIT
P"'160,1 414
DATE 11 J196
VALUATION U,
LOT 108 TRACT Z -S 1 J
JOB SITE ADDRESS 44480 F RONTFR.RA D.fiWE
APN 604-265-001
OWNER
CONTRACTOR
ROGER SNF1J,EN13PRGER & ASS,
ROGER SNELLENBERGE, R Rs ASS
41865 BOARDWALK #212
41865 BOARDWALK #212
PALM Min CA 92211
PAL.M1 DESLRr CA 92211
(619)177-7766 C8L## Im
(61.9)777-7766
DESIGNER/ENGINEER
CHARLES D. GARLAND
33-163 CATHEDRAL CANYON DR.
USE OF PERwt'i QLLi' A % 1 G
('kTf")R At. r. ' C 0!:fid 770-7
Qfl1NTURRA - `J1kAC"J' 239:13 PHASE 11
PLAN 3R
FEE DESCRIPTION
FEES
TkACT CONSTRUCTION 2.359.00 S1-
PORCHIPAXIO 49.00 SF
0ARAMYCARPOR'I? 587.00 SF
ES1'W15'MAI'E D COST OF CONSTRUMON
140,250.60
P.F,RM.ET IFFM SUMMARY
PLAN CWK-CK FEF 101-M-439-318 $650,93
CONSTRUCTION FEE '101-000-418-000 $783.00
MECRANICAL F131 101=0€ 0-421-04(J $68.50
ELE.C'TRICAL FEE 101-000-420-000 $182:82
'P1-Uiwt ING PTT 101 -QW -4;19-000 $174.00
nONG MOTION I� GF - msm 100.000-241-000 $11.03
GRADING FEE 101-0(30-423-000 $20.00
JNi•,1WfRUC`J'UItE FEE 225-(1W44i-342 $3.140.98
AR's 71°11'i�t3,T<IC P1.ACE3 - RESCC 7tJ:t-(1()f3-25S.0fJ0 $1(10.t�
SUB -TOTAL CONS"TdtUCTION ANP PLAN CI-{.ECK
LESS PRE -PAID FEES
$0.00
,'O1 AL mairr tum DUE NOW
$5,113,88
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
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
Final
Final 7,X
BLOCKWAL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPR VALS
Gas Test
Electric Final
Waste Lines
t AY
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
CK for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) zj
ELECTRICA AP ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
AT„bn 82-879 Highway 111
l"`.ce: Indio,'CA 92201
Document Cannot Be Duplicated 61 q_77r%_A51)n
CERTIFICATE OF COMPLIANCE
Date 1/3/96 APN # 604-265-001
No. 14007 Jurisdiction La Ouinta
owner NameRoger Snellenberger & Associates Permit #
No. 44680 Street Fronterra Dr.
Citv La Quinta
Tract # 23913
Lot # 108
Tyne of Development Single Family Residence
.-Comments
Log #
Zip 92253 Study Area 233
Square Footage 2359
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 2,359 or $4,057.48
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed proiect may now be issued.
Fees Paid By Roger Snellenberger & Associates 'Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $4,057.48
Check No. 10634
Signature FJILLno
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Mplicant/Receipt Copv - Accounting