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LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 4882 �W �t�c—
ontr;�t!csrs
1'1r '1f�, x
License # LicClf r
Date SignatureofC..;'
I hereby affirm that I am exempt ffoK the 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 of Owner
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 Section 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 section nrtegq rLo, • completed if the permit valuation js fo` 00.00 or less).
�lli.�Xl tJ i 4 4.`.�
() 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, and agree that if I should become
subject to the workers' compensation,provisions of,Sectibn137001of the Labor
Code, I shall forthwith comply with thosre�tpro 'sins,,,. "'��,/7
Warning: Failure to securecTirm
Worker Compensation coverage is unlawful and shall
subject an employer to ipenalties 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 w9rk is performed under or pursuant to
any permit issued as a result ofithoisapplpcation.agrees to, & shall, indemnify
& hold harmless the City of In iiHn^41fe;IIs, it1Vb—fficers, 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.
X16{ 7,0?2
TION
JOB SITE ADDRESSAPN
3"00 �'i ON- 'MRA DRIVE 6"2-72-002
OWNER
4 965 BOARDWALK H-212
PALM, DESERT CA 92211
(619)'777-7,760
USE OFPERMIT,- JrD AN—UL, .DWELLDIG
R0 0ER SNi'Li,l-MBE#t,Cl,ER &ASSSOC.
411,16513iMltlNV.aLIC #212
priLRi DESE1kT CA 0221.
DESIGNER/ENGINEER
r11ARLES 1). GARLAND
33- IG CAIM)RAL CANYON DFL
f, UIN'ril,1WA i
PLAN I.
z' RAC`I' CONS'C.IifJ(: HO:N
C?ARAO&CARPORT
2,015.00 SF
626.00 Sl:
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 e
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for in9p_.ection purposes')
Signature (Owner/Agent) Date RECEIPT
B -='A1. CONMUL% ONO AND PLAN CHECK $1,416.88
LESS PRE -PAID HERS $0.00,
0
FF& O ' AL PERMIT FE F.15 DUEE NOW 54,476.8 8
g 1996
INSPECTOR
ESTIMATED COST OF CONSTRUCTION
PERMIT ME SUMMARY
P�'LM CIVICS MR,
1.0(-000-439-315
C:ON81RUCT10111 1F EJ3
101-000-418-000
$716.50
MECHANICAL FRIT
M-000-421-000
;$150
1<:I.EIr RICA..FEF
10.1-000-1210-00(0
1%irt,'F4L�.�IN0 FFF.
•' !O1---41-00
piA3.S3
$1..54.00
STONG,MOTION' - R.ESID
101-W-2.41>000
$12.17
ORADINGI;•x;-
1014)00-4,23-000
$26.00
€.N-FRA.STRUCTURE FF.E
225-000-443-342
5211747.89
ART fN PUBLIC PLACERS -12 .
II: 701 -MO -255-000
S54.,u1
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 e
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for in9p_.ection purposes')
Signature (Owner/Agent) Date RECEIPT
B -='A1. CONMUL% ONO AND PLAN CHECK $1,416.88
LESS PRE -PAID HERS $0.00,
0
FF& O ' AL PERMIT FE F.15 DUEE NOW 54,476.8 8
g 1996
INSPECTOR
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
BLOCKWALL APPROVALS
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 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 LateralPool
42
Cover
Sewer Connection LV
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/2/96
No. 14098
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates
No. 44800 Street Fronterra Dr.
APN # 604-272-002
Jurisdiction La Quinta
city La Quinta zip 92253
Tract # 23912 Lot # 104
Type of Development Single Family Residence
Comments
By
Permit #
Log #
Study Area 233
Square Footage 2015
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 2,015 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.
:r
Fees Paid By Roger Snellenberger & Associates Telepirne .-.-
Name on the check
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
Check No.
Signature a�_ A) IAA' L'_0AA
$3,465.80
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