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9602-143 (SFD)LICENSED CONTRACTOR'DECLARATION N 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with W Section 7000) of Division 3 of the Business and Professionals Code, and my = M License is in full force and effect. u7 License # LidACIN6 U Exp. Date 121,W97 N CC r- n Date I. ,11- Signature of Contractor (0 P OWNER -BUILDER DECLARATION J IU I hereby affirm that I am exempt from the Contractor's License Law for the CL 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). ( ) I am exempt under Section ' , B&P.C. for this reason � Date Signature of Owner N WORKER'S COMPENSATION DECLARATION EL Q I hereby affirm under penalty of perjury one of the following declarations: C) 2 Z () I have and will maintain a certificate of consent to self -insure for workers' LO HO compensation, as provided, for by Section 3700 of the Labor Code, for the X W LL performance of the work for which this permit is issued. Q J _J () I have and will maintain workers' compensation insurance, as required by m Q U Section 3700 of the Labor Code, for the performance of the work for which this p U permit is issued. My workers' compensation insurance carrier & policy no. are: d Carrier Policy No. ? Z (This section need not be completed if the permit valuation is for $100.00 or less). 00 N C3 () I c4Hfyoth`atllnlperformance of the work for whi6li(tli's5�ermit is issued, 15 1 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 0 Code, I shall forthwith comply wi{� th se provisions. Date: �,/r_ 10 Applicant � /! f �, ., � 4 � �--=�. i , Z �,-, i -��s Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the Cityfof`India%i;.Well's,,ils�offcers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if . work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the • above-mentioned property for inspection purposes. Signature (Owner/Agent) JL )iX tf ,- , i ; �^,1 � . ! r Date =,h_ 10)/ -- ALC # ol/„ A"' BUILDING PERMIT PERMITS tl64i9 14.4 DATE 311196 VALUATION 5159,9 9,R(i LOT 24 TRACT 23913 P31ASE IV JOB SITE ADDRESS APN OWNER CONTRACTOR ROGER. SNELL$NBERGIBR ,& ASSOC:. ROGER SNE1',.1,EA Y'WROK c& ASSOC 4.1565 BOARDWALK 11212 41865 B0jV tl?%VAJ K 0212 PALM DESMT CA 922.11 PALM DESEX"r CA 9221.1. (6 10 9'i`T..'Y7 r - 8T A I wgtz DESIGNERIENGINEER USE OF PERMIT SINGLL 1' MILY DWELL,TNG PLAN 4 FEE DESCRIPTION FEES *I,`ItA.Uf C0RS`f'ItCJG"rJ0N 2730.00 SF C ARAG�f".tXltP©12T—,V*.00 8F P ESTJMATC1i COST OF CONS'TRUC'TION 15?,x.49,80 'PERMIT .1~`EEI SUMMARY .C?I.,AN 014h_ MX 9 i~F 101-000-439-:3.18 $70&90 C ON`a'I"Itt:IG°L ION f'1.Js 101-004418-000 MT,014ANICAL ,FUR 101-040-421-fiN $60,00 � 1.11 kC:TRJCIAt. FEE 101-004-420-040 SISt5.01 Co rn PI J11"W fET i tl t -f((g)-419-OW X 1 0 nn © rn STLS ONG MOTION F - R1r310 tot -ow -2=11-000 SIu.EAO co URAUINO I -.IT- 101.-000.123-400 S OAK) O lidI`1tAS'Mi u:%'1'LlRR FERE 225-0114-44.1-342 $3,599-10 Q � Q 55'iM_ 5149.90 SUXV1WrAL CONSTPUL""TTt NAND PLAN CRVC;h'. ' $5,749.41 LESS :PRE -PAW FEES $0,00 TOT.I.P .1"EM RT FEE$ DUENOW $5,7l9.41 RECEIPT DATE 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 nof 0, Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL A 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 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 I evEncapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL NPROVALS 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 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 2/29/96 No. 14183 Owner Name Roger Snellenberger & Associates No. 79-165 City La Quinta Tract # 23913 Type of Development Comments Street Canterra Ct. Lot # 20 Single Family Residence APN # 604-263-011 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area 233 Square Footage 2730 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 2,730 or $ 4,695.60 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 ,: _:`TelepZone 777-7;766 Name on the check it i Y - G By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson R' Payment Received $4,695.60 Check No. 11318 Signature P_'PJ� A n��-ALAkD,,^ 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