15799 (AR)' P.O. BOX 1504
Addrd'69 Buil44-8613 Fronterra Dr. LA QUINTA, CAL FORN A 92253
iii
Mailing
Add ress2-65 Boardwalk., Ste. 212'
City Zip Tel.
Palm Depart, ids 92212 (619) 777-7766
Contractor
Same
Address
Tel.:
State Lic. ' City
& Classif. g 4.88234 . Lic. # 1858
Arch., Engr.,
Designer
Address
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmjthat I am'licensed underr rovisiohs of Chapfgg Q (commenciQig with Section
7000) of Division 3 of tl)e Business and rofesssiLpns.,Co�de,g1?r mmy license i n full force and
effect./if lam- 7i C Y�'`�,'L:C��
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged. exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or 4nprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with I icensed *contractors to con-
struct the project. (Sec. 7044, Business and •Professions Code: The Contractor's License Law
does not apply to an, owner of property who builds, or improves thereon, and who contracts for
such projects with a contractor(s) pcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy o. Company
Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for' one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date �Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND'
I SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to, building
construction, and hereby authorize representatives -of-this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant g� —Date—
Mailing
ateMailing Address
City, State, Zip
No. 15799
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 604-^272`004
Legal Description Lot 102 Tract 23913 Prase 1
Project Description Master bedroom extension
Supplemental to permit 015673
Quinte"- rr?
Sq. Ft. No. No. Dw.
Size 109 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $5,919-.00
PERMIT
AMOUNT
Plan Chk. Dep.
_
Plan Chk. Bal.
52.55
Const.
81.00
Mech.
0 00
Electrical
3.82
Plumbing
.00
S.M.I.
.59
Grading
.00
Driveway Enc.
00
Infrastructure
133.18 .
Arts -In PUbl.ia Places
14-80
TOTAL
286.04
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.'Line
Side Street Setback fromt\ine
Side Setback from Prgpe Lin
FINAL DA
Issued by: Date "�- rn
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES ~
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE ,
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) AV
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ,
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) AV
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 9/22/95 1 Type of Permit I La Quinta
No. 113703 Permit #
Owner Name Snellenberger & Associates Log
No. 4486Q5 St er a 7F5-Dr---Dr.
city La Quint � zip - 92253 Study Area 233
APN # 604-272-004 1 Tract # 123913 Lot # 102 Square Footage 1109
Type of Development Residential Addition INo. of units 0
Comments Addition to new construction, extension to master bedroom.
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 109 or $ 187.48 have been paid to D.S.U.S.D. for
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 & Asociates
Name on the check
By
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature �� .Q�,�nD \ c` 4 ,tAA.�,y
Telephone -
Payment Received
$187.48'"6hec-k No. 9367
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