9607-029 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
co , Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Professionals Code, and my License is in full force and effect.
O coy ► License # Lic. Class Exp. Date
I\LLJr- 238947 L -5i a/ 1.196
T OZ r Date's !! 1 Signature of Contractor
4,,��-4 1R( I
P: M OWNER -BUILDER DECLARATION
JU(0
Iii W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to 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 exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
<'')LID() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q () ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
4 Z permit is �ieidMywoMe�s' compensation insurance car•r�erC& 1pol;cy,Q. are:
Cartier Policy No.
co 0
0 :.
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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
the above-mentioned property'for i,nspec ioQ p f�oses.
Signature (Owner/Agent) �Y � ` IV* Date �i i7r , �
BUILDINGPERMIT PERMIT# CONTROL#
/`=A
rY
9607-029 36903 6 9 Q
DATE VALUATION LOT
7/11./9C S12.500100
JOB SITE�•
ADDRESS "115 CA 11 ER" �imw,
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
OCF.111N Si ANI%IN'S'
MAS"TFit DOLS
74-4 13 CAN'['i?RRA DRAVE
`
73565 HW Y 1:11
LA QUINTA c.;A 92253
PALM DESEM' C;A. 92260
(619)V16-6115 030 16
USE OF PERMIT
1100i,1%NI lrf.* SPA
P 4A. ONLY
1"f. 0L r\IJ i0k 3i'n 12.5E}f/.f7!1 f13
ES?I'iMs1'IG'ED COST OF CONXINUCf ION
12,500,m)
TFIMIT FEW, SUMMARY
f"(.ANf'-fl XX.PM, $!)3.60
, X.)N,3ffl1 fr"' t0N FEE 101-000-11$4300 $14!.00
MI-' IIA:NTC. % Fib. -- P001. 101-000-421-000 $24.00
1 "sl: - PfWfL. 101 -(K10 -d2{) -WO $45 (9)
P0 JK,,ft1t 1C1 Fl li -- PfX31. 401091,419-000 52.7.00
it
SU.i3-'IC+1'11L �`{hiS'1"f2[CT1'Ji� :?LNTJ'.LA:YiC
-$333.60
LESS PRE -PAID FES
$0.00
At PR.R.M.11FT FREN 01% NOW
UK
JUL
RECEIPT
ATE '��
BY /�
DATE FINALED
INSPECTOR
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 Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover Y V/101
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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 Lateral
Pool Cover
Sewer Connection
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 4/17/96
No. 14339
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Roger Snellenberger & Associates, Inc.
No. 79115 Street Canterra Dr.
City La Quinta
Tract # 23913 Lot #
Type of Development Single Family Residence
Comments
APN # 6047-262-020
Jurisdiction La Quinta
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.
Fees Paid By Roger Snellenber & Associates, Inc. Telephone 77f-7766
Name on the check
• J
i' �
By Dolores A. Ballesteros r `
Superintendent
Fee collected /exempted by Pauline Pearson
Signature & A jjna 2 2 Al A n
Payment Received $3;465.80
Check No. 11830
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
_.- •--+ART-. _5'i........_ � .. ..... .._ _.- T:lY� - �.....-
F�
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Epp
MWE M I AI.
Designers & Builders for over 35 yeay.s yr
73-547__H1gtjwy,111lJfensen's..hopping Center i ^ -
.
619-346-6115
State License # C53-238947
'S
ACOIIGl4AMOS 11 CORDER 140 AGIW9
�5 a
a
} SPECIFICATIONS.
Six. f uolurneedlnna-
Tenrpd a re Np. 9p�ti [pe
rS11r1arGF - r•YflfileS7F .�—i}F-
DepthL: lrLirrl h4ar<Lzmum _freak
$pa5;xe =- I3ii4Y -- ---Y44urne
EXCAVATIDN
Finish Elevation —TZ'PNklhotl;fz. )
Acc*t% f Site Prepmmion
Gif ading --
❑itt RWngv#rlLoads l0 dump,
nfV Mall LOCK, Oft
I'enCG Re+zsGved I3 Rapl�Cgq BY z �llizlrl3l
Slxe of Ope-1g _
NOTE. No punting OF r EXIIIiF100! texture nn11 be darie!
PLUMEI NQ
Filter
Pump Type Sire
5k.Wrrier TYPr - EEL;', T4[e
Haw? Tyoe._..- .4m _a
Hraier Vem By n:lc
Jrt Pum¢ Tyr^.�fSA'1h4r5+�Si.[e
RI over Ty PIE —Srxe
r=quipmenl Locaupn fCStadr [
Piurhbing'Aa[eful-
SuCLdh� LangTh— Fz, Discharge Six[Z_ Lgth.._._. F ee[,
Witte To --$tee LengM Pest,
#iawrus in ?tiol I bee S.Za �.. Length Feet
RsLum Irlael TV pe . I_e_
Fili Lino IWith logo 2girucronFI- W5 VLive is]Stiae�gz .. atlfxr.
Gas Lir-e BY Ai -Site Lnn¢rh Q P"t.
Aazomet;c Cleamnq
SPA INFORMATION
SuCt*rl,. Siee m. — FI.
Aschq.Som — Lgzh ._-_
Feet
Jet Type
rausnger
Jet Air 'Line Number Sire
Lingrh
No
$Im'rver ROzurrl Size
Lerlgzn
F#IL
$eh,mor Halve: Type—Numbrr'
Fitter Type -Size
-
Pury Tv"
Slre - -
Skirnrner Tvpe
'SI{e
fleeter Typ- _ _ _
Si -
Heater Vent SY --
Jet Pump Tyr.'
Blower Typ+
5ice
EgUipment 4-matron
PM'aiaEJpit
Plumbing Material
Suctmn. Si:■ Length. Ft.
Dimhuye Sias! --Feet
Wijf to To — S;:e
- I. moth
Feet.
Returns in Pc4L_ Nurnhomor
Feet.
RgtWiTj lnlez Type
--
�`
Fiat Lima 1WIth No Odsrrvetionsy5lre._l.Qzh. FL AtS Valve Location
Gas tlfie by 'Size
Een¢sh
Feet-
Amornatic C9sanuv
- - STEEL
-
Raisad 6.pntl Stern. B" —.12" , IB";�_Other�
Spa dam Will J _!L.+rL tit---
�ac�,�-r
QUINT
4 f
Nk Nv
r DATW -
sy
SCALE 111OWN. BY iL�LII
T]
Corner �i II- f
GUNITE.
[FaDIN 3
Une LogaGun
Grip Rail _--
viand Rail —Cup Anchors
S*&dBeiich '--
Spa lAforrnairOn
TILE ANOryCCOPING
Tiie _ONO -
Cantilever �
-
Trim:
_Mpmbirad Tile
9 rick
$pedit Dmiil Sa "STEEL".
"GUNIIE"
ELECTRICAL
Ely: M . 'T. 1,9ht4_L_Q _Col•d L*W Peex-
" J" Boa Lc"nom 21Y Swimh 1, =t;
Fitter Run - Fz. Jez Run F1, L*ht Rua Feet
SuitCh RVn Ft. panel
Spa SWITeh "von
Hii,Wr $1YilCh Lwalipn
DECKING
ev :23:A.C�jFinLp . FT . .
Color ['yImWever Rtll Anchors
Rluirs _ FL Exosr4siork:
Standards: _,-_9narzilSlida
Uepk Orer ; �--
- - P4.+f+STIFA
Lois !+tame PIL1el D Recessed Szr¢�
Cup Anchors Rail Archorm Gr11Is
_NAME
ADDRESS
CITI
ONE
AREA, T 4
CHK. BY 11 SHEET OF