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9510-055 (SFD)H W O d LO I�. W C O� �P:_CY) LLI CL U) Z LICENSED CONTRACTOR DECLARATION I hereby affirm 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. Q e License #_ Q 13 Gass 5/�),�0 Exp. Date Date o 7 SignatureofContractor , k i )I V OWNER -BUILDER DECLARATION I hereby affirm 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. ( ) I have and will maintain workers' compensation insurance, as required by Section 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 +r n •rr.�rti-oma Policy No. nn�nn�� ep (This sec to nn eed nc 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,tho"i rovisions!) _ ,,,+► 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 6f 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 r any permit issued as a result of this application agrees to, & shall, indemnify & holdharmless the City of Indian Wells, 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. { 1 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 pioperty for inspection purposes. Signature (Owner/Agent) Data ""' BUILDING PERMIT PERMIT951( 155 DATE 1.215/95 VALUATION $01,035 F7 LOT 2 TRACT RI K. 12I JOB SITE ADDRESS -785 AV1+;NIDA 13'E',ll�MUAA. S APN 773.18"94 OWNER CONTRACTORf t r VV1LUTAM,J, COX & SONS WILLIAM I COX 66900#O11„LON R'D. 51.785 A'VENIDA BER UDAS PALM DESERT CA 92261 LA QUINTA CA CA 92253 (619)1251-3790 CAL# ' MS DESIGNERIENGINEER ( USE OF PERFAT 11,F r AANLY DWELUNG gNC Pernik does UCA inch.Ida Block. wall or pool.. FEE DESCRIPTION FEES TIZAC'I' CONSTRUCTION 1,257.00 'SF PORK /PATIO 14$.00 SP GAl?AC0CARPORT %4.00 SIF ESTUNIAT.113 4.NIST OF CUNSTRUCTIION 80,035.40 .I ERM4T 1.+EE SUiMMARY "DEPOSIT 4250.00 PLAN CWCK FEE 101 -MO -439-318 $469.13 CON%TRUCTIONFEE 101 -000418 -OW $551,60 LO M904ANICAL FM 101.-000-421-000 $47.0 � UEC'IRICAL F� 101-000-420-000 $1.17.58 i KIUMBING FFIE 1.01-000-419-000 $127.x0 0D STONG 10.o`�TION M- 6 - IZESIIU 100-000-2,11-000 $8.04 Q U GRADING F:EE 101-000.423-000 $20.00 t'-1 INC:12Aw)JIt(ICTLTRE.PE13, 225-000-443-341 PRECISE -PLAN 101-000-441.3,4S $25.00 _C—�� SU)3 WrAL C:ONSTR:UCnON AND PLAN CHECK $3,126.25 LESS PRE -PAID FEES 4250.00 Tf: TA1, Y RMIIT FE&SWE NOW 52,876.25 RECEIPT DATE BY 1D!1JtM INSPECTOR INSPECTION RECORD 4 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs / Underground Ducts Forms & Footings/ Ducts Slab Grade 0. 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 POOLS - SPAS BLOCKWALL APPROVALS 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 Encapsulation Gas Piping Gas Test 3 9v Appliances Final COMMENTS: 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) Notice: Document Cannot Be Duplicated Date 12/7/95 No. 13946 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Owner Name William J. Cox & Sons APN # 773-184-014 Jurisdiction La Quinta No. 51785 Street Avenida Bermudas City La Quinta zip 92253 Tract # Lot # Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 112 1257 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 1,257 or $2,162.04 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 William J. Cox & Sons Telephoile,,,251-3780 Name on the check , By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Signature ��t P A UAZA--L 1`e i y., A Payment Received'' $2,162.04 Check No. 5137 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 Building Al,'Address / f" t � Owner T4ht 4 P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO r `A V j t A�,QUINTA, CALIFORNIA 92253 L_�_) )-1 " h < C=, y �_ `� C° 1 BUILDING: TYPE CONST. OCC. GRP. Mailing A.P. Number 3 y d f y City_ Zip Tel. �- \ Legal Description Contractor Project Description City State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). l7 1, 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ( 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company (7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION ZONE: BY: Minimum Setback Distances: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback jro�� Side Setback from"P pe t, Estimated Valuation IN. PECTO PERMIT AMOUNT Plan Chk. Dep. f ,� Plan Chk. Bal. " r Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Rear Setback from RearfP'r Side Street Setback jro�� Side Setback from"P pe t, FINAL DATE IN. PECTO Issued by: Date Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL, SO. FT. FORMS SEWER OR SEPTIC TANK POR. SO. FT. CW MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SO. FT. 0 TEMP. POLE WALL SO. FT, (L GROUT DRINKING FOUNTAIN SO. FT, 0 FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. B c BATH TUB GAR. FIREWALL SO. FT. © c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID () v/a c SEWAGE DISPOSAL SO.FT.GAR 3/4c HOUSE SEWER INSULATIONISOUND GAS PIPING PERMITFEE FINISH GRADING PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu, yd. g plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 16-14 2. V > 78495 CALLS TAMPICO - LA QUINTA, CALIFORNIA (619) 777-7012 OF Tt`� FAX (619) 777-7011 FACSIMILE TRANSMITTAL To: Attention: Fax Number: From:Building and and Safety Department Date: �%�25 Page 1 of 2 - Comments: Comments: - &-gvri-64nE of Oce-ue4Aky heSi - SAAR jME�1i �� 3� Fi CKC.A YOU,2 MAILING ADDRESS - P.O. BOX 1304 -- LA QUINTA, CALIFORNIA 92253 art r of ug Tit�r of IlttI�uinttt lliltitbin� 'anb �`afet� 3341tbeithin This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS 51-785 Avenida Bermudas Use Classification Single Family Dwelling Bldg. Permit No. 9510-055 Group R-3 Type Construction VN Fire Zone Use Zone RC Owner of Building William J. Cox Address 51-785 Avenida Bermuda City La Quinta, CA 92253. Daniel P. Crawford, Jr. BY: —� Date: September 25, 1996 Building Official POST IN A CONSPICUOUS PLACt s