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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