9606-110 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofperjury'that I ani licensed under provisions of.
Chapter 9. (commencing with_SectioW7000) of Division 3 of the Business and
(V W Professionals Code; and my License is'in full force and effect.
O Z) co License # Lic. Class - Exp. Date
�0LOLLJ
r � �
oil
Z✓ ate `• i S Signature of Contractor—,
C° f— °� t OWNER -BUILDER DECLARATION
LU ujM I hereby affirm under penalty of.perjury that I am exempt fromnthe-.Contractor's
U) License Law for the following reason:
Z_ ( ) 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 exclusive.ly, contracting with licensed
contractors to construct the project (Sec. 7044' Business &. Professionals
Code).
c O I am exempt under•Section B&P.C,for this reason
LO
N Date Signature of Owner .
O / r 1.>
Q WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby. affirm�bnder, penalty acf perjury one of the following declarations:
r � O () I have anii�will maintain a�certificate of cons7"ht to self -insure for workers'
X W compensation; as provided for by Section 3700 of the Labor Code, 'for the
mJ Q performance of the work for which this permit is issued.
Q C)( I have and will maintain workers' compensation insurance, as required by
0 O Q Section 3700 of the Labor Code, for the, performance of the. work for which this
OH permit is issued. My workers' compensation. insurance carrier & policy no. are:
It z Carrier• . _ Policy No.
00 � si A:I9,flu b h�irJti �+fi
r0
J (This section need not be completed if the permit valuation is for $100.00 or less),
( ) 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 tb the Workers' compensation provisions':o ection-3700 of the Labor
3 Code;�l sfaa I -f-q thwith comply withtos pro siori;
!Date:u `� Applicantt�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby :authorize -representatives of this -City to. enter' upon
the above mentioned propert',,Ifor inspectioenufpo es.- (�
Signature (Owner/Agent) ,� 411 Q
Date
BUILDINGPERMIT _PERMIT". c°NTR°`#
43
DATE . VALUATION 'LOT 9�00 TRACT v
�'d-fi`�!'l� . -: -:. � , <:;�f1�:�9,(i�S"d �4?. .,�,3•f.� �-' - • • .. �3t�4.� i'�:;�e
JOB SITE
APN
ADDRESS-f,
DDRESS�iJ�{��$I � �'A���£51:.�6�.^� ���A�•V��o
'. -,i��lf`G��.��3 ..
OWNER -...
OWNER-
CONTRACTOR / DESIGNER / ENGINEER
X, '113
a: LlT�
�V���iItl
t�t�Gyf
z'.A.t N1 ,);4a8H,_K V'' CA. 92211
AAI;tb!, Dk S8t'I" 6f1 92211.
UNA .18-58
USE OF PERMIT
PAM 1tii'il l
A3-IrS"1 i d"f'lt'01 Al. C; I'lk,.
CITY, CA. 9,2214
PLAINJR
TuWA, C1QN5TRu( 0N, 13590) 3F
CARX(I ✓!(:alRPOIZ31 64 9,00 SF
d�.9�tfll�lf '. D ► .ft$+°�4�3' Y .4t v i( IN
1a;6 f.:9�ti
L'UR.114IT IME, tNU4V4i41IARY
CUNSTRUc,°Hc N FM3
Lt�.cf,�311��tiyIC 1,[`l-1:
Irf �ta A.vJ.*.o�V-/ �.T }� �LAwIJiP.+"''(Q•V'�[tJ�D �D I.�'�.17Y
1>.r.;t.tMBIWO FTM T.t € 01 r{ ?i Al 9..{){){)
STOW; NSiYl" -)W FFT -�U,8[ J 161-000-M-000 14,07
GRADIN S H S2(i:t�Li
01FT nSTR.W,T-0WE ITUT 225-000-443-342 5z 164 79
;ART IN s'(M-W _VJ.,.A,Q138 - RF,114C 701 -OW-2,55-000 �:103:•�
L � ' 6` iRT�.1 Y'�,Vtlw•S Vick d`t.S �tyA1.,i.'.�C,1'i�j•Vl�ta.t(•7[.fa:nCy'�K
� $561Q3�N�,7
}fit
LESS C�iS.�E'�1�.AJ'LJ.O EES
sylu.�
SEP 3 0,19961 .AL 1-T Dill-FEES1)V4r_, �
,134m
rRECEIPT.INSPECTORDATE.,
BY (
DATE FINALED
INSPECTION RECORD
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 LathAo—
Drywall - Int. Lath
Final
Final
BLOCKWALL P ROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg, 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 leffO.K.
for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICALAPPO OVALS
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 9/25/96
No. 14875
Owner NameRoger Snellenberger
No. 79-050
City La Quinta
Tract #
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Canterra Drive
Lot #
Type of Development Single Family Residence
Comments
APN # 604-261-006
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Square Footage 2359
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 1.84 X 2,359 or $ 4,340.56
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 Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Ellen Patino
r
Signator
J�=(�
Payment Received
Check No
Telephone; 777-7766",
$4340 56
13678
k
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