9602-032 (SFD)I—
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LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with DATE V 61
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 481231�'3
' �,.w �+ JOB SITE ADDRESS
License # Lic. Classdi Date
OWNER
Date Signatureof Contractor :i, ,: Z,%
OWNER-BLIILDERAD LARATION
I hereby affirm that I am exempt from a 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 of0wrier -
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 $action 3700,of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This s"� d r%%a completed if the permit valuatioon-jos Jpa$� 00.00 or less).
O I cert fit at In the performance of the work for whicthis 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 p ovlslons,of Sect' n 3700�of-the Labor
Code, I shall forthwith comply with th/ose'provi Ions ° j .•~
iDate: Applicant
Warning: Failure to secure Worker 'Compensation coverage is unlawful and shall
subject an employer to crimp 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, indemnify
& hold harmless the City oft1644n!Welld,401officers, 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 i spection.purposes�
Signature (Owner/Agent) Ff 1V: � ' �✓ Date
ILDI
44-710 FRONfER.RA DR VE
ROGER SNELLENBFRGER, & ASSOC
4186.5 8OAl2DWALK -I i2
PAJX .DESF-fit: C CA 97211
(619)777--7Ww6
USE OF PERNSINGLE . FAMIL Y
QIJ1'NTF-RRA.
PLAN AN I
PTI
TRACT CUN5:1:`itiJ(7T10N
GARAC1s!C4RPORT
4602-032
APN 604- 654RIZ
CONTRACTOR
ROGER SNELUNB1 RGER & ASSOC.
41.86-5 BOARDWALK 92J2
PALM DESERT CA 9221.1
(619')777-7766 CB1.0 1858
DESIGNER/ENGINEER'
33-163 CK114EDRAL CANYON Inti.,
2,015.00 SP
626,00 sF
E STINIATED COST OF CONSTRUCTION I '121,4;94. la)
PERMIT FEB Si31d1f14!1(ARY
P1, AN CRECK QEF
147 -(W-439-318
CONSTRfiCT1ON:FIX
104•-000',-418-000
Iv1PtNAT�i'1CA1.1 EL" `-
told}�;1�=�ia1�()fY
1}LECI l ICAC :r RE
101-000-4 o.-000
PLUN4DJ1NG,'- rtJ
101-000.4194()(),.
STONG 140T1GN FIM -'RSSI )
101-000-241-000
0RAt) N0 FLE
101-01104423-000
1NI'-RA.STRUC:TURFFEE
2.25-000-443-342
SRT IN PUBL) PLAME - RESID 701-000-255-000
3597.4►6
-•.
153.50
co
$131.55
C ac')
$154.06
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.GrGV.titi
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$2,737.39
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$54,21_
Li
S -UB -TOTAL CONSTR(FCT1ONvT AND PLAN CHECK
LESS PRF4A1D .F1w.BS
TOTAL PF,1tNIT 1±EES DUE NOW
DATE IBV
FINALED
$4,476.89
$0.00
54,476.
INSPECTION RECORD
OPERATION
'PATE
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
,iIg Final
Final POOLS - SPAS
BLOCKWALL P ROVALS 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 O.K. for Finish Plaster
Sewer Lateral dzPool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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) a
Yf
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14110
Desert Sands Unified School District
82-879.Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 44710
City La Quinta
Street Fronterra Dr.
Jurisdiction
zip 92253
APN # 604-265-002
La Quinta
Permit #
Log #
Study Area 233
Tract # 23913 Lot # 107 Square Footage 2015
Type of Development Single Family Residence No. of Units 1
Comments
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 2,015 or $ 3,465.80
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. ; h
a-
Fees Paid By Roger Snellenberger & Associates Telephone `
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,465.80
Check No. 11027
Signature N, At , A 6 n„ u
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