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9604-055 (SFD)I{ N W W Ouch C3 u7 W T Z n 0� T I W W O H lL Cn Z co LO N ON U °) ,aa Lr) cr— �- 0 X W Y: 0-'Q M U U O to H Z co � Cd 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 Date + t`T_ Signature of Contractors 1 _ r_ ! ,? •. - L 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). (" 1, as owner of the. property, am exclusively contracting with licensed ontractors to' construct -the -project (Sec. 7044, Business & Professionals Code). '�� `-,I - () I am exempt under Section B&RC. for this reason Date Sigriature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maihtain 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 S ction 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 `2 q AT1i 1qTf4b Policy No. ti2<�:�`+S<)5 (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' compensation provisions of Section 3700 of the Labor Code, I; shall forthwith comply with those provisions. _ DateA!I `1 ral, Applicant /{ . / t ..1 . 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 property for inspection purposes. Signature (Owner/Agent")—.t j 1 41 L 17, Date–k f t u}1�tii _ BUILDING PERMIT PERMIT# CONTROL# 9(414.0g5 3138 DATE 4/17/96 VALUATION S• 121,684 10 LOT I 34 TRA`T, I .; 1 X11 S JOB SITEADDRESS /0-I N�Il..�iV�r�.,�{l�.tk �}RM, APN OWNER CONTRACTOR/DESIGNER/ENGINEER R'.;K1J',R SrJ1' 1,1. lil;t;al.lt & ASSOC ;;695 PE 13131,L BEACH sus PEBBLE a-PAC11 LA QW91-A CA 42253 LA Q(.IIM'A CA 92253 (619)777-77(W, 1814 CHARLES V. 43,ARLANI) USE OF PERMIT SINGLE FAMILY OWELLINC A3-163 CA!HFA)RA.F. CANYON f_)R. - CXrHF1)RAI, CITY. CA!f 22`141 001 NTF:IMRA KAN I ` , � TRAC7t'CONSTRLI(:1'Ir_)N 2110115J*SF / AIARACIF%CAR['i;rflT 6126,00 SF ��.�►i j�i�li' ;T3+Ct :4i� t;t3iYS"!' #[1t Ff3i�i 121.694.10 PERMIT VIEW SUMMARY PF.+W t;'1M.C•K FE11! til-{113tF X39 -z18 !4ty71 COINSTItt1CrIONIII", 1,01.000-=l1R-000 S;1S.SI.I f411 CRANI AL FIT. 101-itfl+)-421-ON 1,117r"f111C;AL FE''F " I01.000 -420-M) I'T.tif41Fi1Nt'71'•'F;i; t(fl-tF{H1-•11+f•{)(Nl blw.ritl :iff:)ijCl WAVON 111:11- ftlns 1) 101-000-241-000 $12.17 © trn7� r O AMNO Rili 101 -W -423 -CM INFRA. 1'R1K,t11RV FEE, 225.110)-X14:1-342 tY At�•1' iN N(rr;f,t , i'7,Ar�+,:l . 111;;11; 701-ft(1Q:; St.{F(� SsI w1 a p� ` Q t i Sn1-TOTAL CONSTRWMION AND PLAN CHECK $4,476.89 LESS PRF -PAID RES so.W TOTAL, YERN11'1''1`'fi:M !:►lJ1N� NOW' -U,476M RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings 176 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL A PROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location U' derground Electric Underground Pibg. Test Final I qps Piping PLUMBING APPROV LS Gas Test Electric Final Waste Lines Reater Final Water Piping Plumbing Final Plumbing Top Out EWpment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 1 L14Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final oe 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) Notice: Document Cannot Be Duplicated Date 4/17/96 No. 14331 Jurisdiction La Quinta Owner Name Roger Snellenberger & Associates, Inc. No 79100 Street Canterra Dr. Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE APN # 604-261-011 City La Quinta Tract # 23913 Lot # Type of Development Single Family Residence Comments zip 92253 Permit # Log # Study Area 228 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. - � . 0 , Fees Paid By Roger Snellenberger & Associates, Inc. Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson = -`Telephone '�777-7766 ^ f , fl Payment Received $3,465.80 Check No. 11830 Signature A � o PO AtAA 64A - 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