9606-108 (SFD)C7
N_ U)
W
O Z) co
F, I3 LP)
W
Z
—0�
F_ 0)
T
W W co
H CL
U)
Z
M
LO
N
ON
UQ
It 11 Z
Lo Cr
0
LL
0 J J
mUU
O
Z
coo O
Q
J
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury 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.
License # Lic. Class Exp. Date
r
zDate� � • � Signature of Contractor f _
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from 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.
XI have and will maintain workers' compensation insurance, as required. by
Secubn 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.
P�a'I.A.'1') hUNE fitiG:i�"3tI
(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 to the workers' compensationpro ons of.Section-3700 of the Labor
ode, I sh Ifo hw1'th comply with those pr.ovisi�s.
VDate: O 1 u Applicant
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
th above-mentioned property fors spection.p ,rposes:-«- A
i t
ignature (Owner/Agent)` Date L S
I � �—
BUILDINGPERMIT PERMIT" CONTROL#
4041
DATE VALUATION LOT 96116- 4IN TRACT
WIV96 $121,684,011 31 23913 VH6
JOB SITE
APN
ADDRESS 79-070 CANT RRA `RIVE
OWNER
CONTRACTOR DESIGNER ENGINEER
. i:t&AS:C
�;k�LiZYN�lX111111:,,�R ULSSOC' .
41-865 B0A1t13'4V.ALK, SU11t- 412
41-865 80AitONVALK, SU1'71: 212
PALM fMSEfUl' C'A 92211
PALM D1;S131i:1` CA 41211
6)977777Q.)
61977777CiC' C'1;[,fE 1858
USE OF PERMIT
i.•idFtli.l.M. G. Catl' ANT0
N; N01 N. VAhJf •. i {k .i.thte
i'l-t zr 114r pan t #VV0nr 00
Qt UN'I`ntR A,
.13LAN IR
IltACT t.0N81Tt0C'J% )N 2,ots.rx� :str
GARA(WCARPORT
YERMI T 1! E1C' SUMMARY
PL N C,'f4l.CK i4T.18 101 1100-43 -:1113 $5A7.gt5
COA1491'F2E1C`iION FEE 101-0004R_000 5716.50
1v11It:1#ANit:A1. Fff:s . 1.01-000-42i_000 $1,5150
1 ,W.17RICA1, FEE 101-60-42(MOO $131.95
pr,[.tNTBIVII FIT $154.11114
ab`41t;%W; M(Y1'IONIV ;-1CMD 101.000.241-0m $i-2.17
QRAl)IN1C3FEW WI -.000-423-000 S��i.cKl
11N1''1`' A8TIiVy:1`l14E b'FI: 225-000-443-142 52,737.39
ART IN trrx13LIC 1°I,f CE3- RIiS11) 701 -000 -?R5-000 g4A 21.
N.
1�%T��j 4 C4 ci•,tr£d1.J�.r1 ON ANID ,f Sr.['1.i,Y CHIEC.+hr,
�vi4�l}•Cf41
... QJ'
D$4Y4708
;y.
c YAL11c,U�1i1`�°F1'EWU)UENO>~rd' -
SEP 3'0'199 �' ,
RECEIPT
DATE
BY�DATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
02
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL P OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final I I
Gas Piping
PLUMBING APPR V LS
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
00,
Final /
Utility Notice (Gas)
ELECTRICAL AP ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbrtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/25/96
No. 14873
Owner NameRoger Snellenberger
No. 79-070 Street Canterra Drive
City La Quinta
Tract # Lot #
Type of Development Single Family Residence
Comments
APN # 604-261-008
Jurisdiction La Quinta
zip 92253
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 1.84 X 2,015 or $3,707.60
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
Signatu 're,,(J
Telephone' :%77-7766��
Z'
A .
v
Payment Received
Check No. 13678
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