9602-030 (SFD)LICENSED CONTRACTOR DECLARATION
� I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of.Division 3 of the Business and Professionals Code, and my
Ou.) License is in full force and effect.
r w License # LiAdassis`j 1:3 Exp. Date 12/30/97
Z`/Date �,_ tr,_9� SignatureofContractor /� , (i
cTo Fn
OWNER -BUILDER DECLARATION
J Wco
I hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
cA ( ) 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).
O I am exempt under Section B&P.C: for this_reason
LO Date Signature of Owner _
N - r
OU rn WORKER'S COMPENSATION DECLARATION
CL Q I hereby affirm under penalty of perjury one of the following declarations:
C:) Z ( ) I have and will maintain a certificate of consent to self=insure for workers'
Lo cO compensation, as provided fora by Section 3700 of the Labor Code, for the
X w LL performance of the work for which this permit is issued.
p 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
O fJ permit is issued. My workers' compensation insurance carrier & policy no. are:
a rn Carrier Policy No.
't Z (This section need not be completed if the permit valuation is for $100.00 or less).
00
�() I cE6s8fyhtl at4iVtfjelperformance of the work for whibihkh, Ws 6rmit is issued,
Cy
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
A Code, I shall forthwith comply with those pr v sions.
C
I& :2 Applicant 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, indemnify
& hold harmless the City of Indian Wells, its 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
peimit, 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 purrp�oses. +
Signature (Owner/A9ent) �e A? �!/�_ Dame 9--S- 9G.
A"'
BUILDING PERMIT
PERMITi
SiCdfJ�IlBIi
DATE 217196
VALUATION 1%228,391.911
LOT w
TRACT 23913
JOB SITE ADDRESS
APN
AA -776 lei x2 11 %'(1
9AiAA- ' ' a3B'a
OWNER
CONTRACTOR
ROGER SKEC.L.ENSERGER &.ASRQt..
WOER SNELLENBER.GER. &� ASSOC
-11865BOARDWALK WALK #V2
411365 BOARDWALK 4212
PALM DESERT CJV 9'2211
PALM DE8I RT GA 92211
f4ZtO1777_17 A riar :4 IS4ZQ
DESIGNER/ENGINEER
5f 19,777-7760,
OC HAR1.SS D. 0ARL AND
33.163 CATHWRX1; CANYON DR.
USE OF PERMIT
SINGLEFAMILY )WELLING
�. CA1'1ED12AL CP1'Y, CA $Q234.
QLgXrERRA
PLAN 2
FEE DESCRIPTION
FEES
`.'RkC-f CONSTRUCTION 2,149.00 SF
GAAGWCARPORT _97.00 Sr!
b STLilATED COST GFS CONSTRUCTION
128.391.94
P.i�:&+MTf P'I)rE'3i1WINI.ARY
PJ A,N C:1iUM. , FETE 3.01-000-439-3.18 $61$.61
CCiNS:Cti(ICTIONF1;E 101.000-418-000 $741.00
W-)CHANICAL FEE 10.1 -WO -4e1-000 $33.54
1~3.a CIVICAL ME 101.000.420-000 $135.66
PLUNIRR40:!�?'i_� 101-M-419-000 $ I:5 00
S"fS:NGM1 0, [0141C1:E-mmu) 101,,000-241µ01XI $1184
GRADING MIE 101-000-423-000 $24.00
IN}'R.ASTRUC ['U:RE. FEE 2255-000-443-342 $2.888.82
AWI` I'NVRJB1AC 1"..028 =RESIT; 701-000-255=()00
o'�l'13- t' �1ST1�.U�,"I'iaN .AND PLAN Ck�I1rC'
$4,692.41
F� LESS Pi21-PA1.11 FEES
e 0 8
$0.00
g 1996 TAL PERMIT �•EE✓ .S DUE �rOW .
y
;692.4:
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
7,11611
Return Air
Steel
Combustion Air
Roof Deck
,<
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Z
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines .
Party Wali Firewall
Exterior Lath
`Drywall - Int. Lath
Z
W01 JJ6
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Pool Cover
Sewer Connection
'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Ar
Final
14 14T
Utility Notice (Gas)
ELECTRICAL PPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures'
'Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Usebf Power
Final 66 ,767
Utility Notice (Perm)
k
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14108
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 604-272-001
Jurisdiction La Quinta
Owner Name Roger Snellenberger & Associates
No. 44770 Street Fronterra Dr.
City La Quinta zip 92253
Permit #
Log #
Study Area 233
Tract # 23913 Lot # 105 Square Footage 2149
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 2,149 or $3,696.28
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
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature P
-'l elephone ;,
Payment Received $3,696.28
Check No. 11027
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