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9510-056 (SFD)WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of;cii INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts fogill Footings Ducts Slab Return Air Steel AW Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Q(� F.A.U. Framing Compressor Insulation / Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall G Exterior Lath Ad,0L Drywall - Int. Lath Final Final BLOCKWALL APkOVAILS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines zHeater 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 S Utility Notice (Perm) COMMENTS: �J Owner Mailing / Address Ca �% 4-451, City Zip Tel. Contractor Address City State Lia & Classif. Arch.; Engr., Designer Address y.1 Zip' ITeI.. Lic. # Tel. City Zip 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). (7 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, 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.) 11 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.) 17 1 am exempt under Sec: B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 ❑ 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 it work thereunder is suspended for 180 days.. I cectify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING -.,TYPE CONST..- .: OCC. GRP. A.P. Number Legal Description r Project Description , Sq. Ft. Size . . No. No. Dw. Stories Units . New ❑ Add ❑ r Alter ❑ Repair ❑ Demolition ❑ ;timated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure ^e TOTAL % J REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fro C ter Line Rear Setback f ar p. Line Side Street Setj from�e Line Side Setbac r Propeilne FINAL DATE NS E, R j Issued by: - Data (3P,(E1it Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ 2ND FL: SO. FT. d POR. SO. FT. @ GAR. SO. FT. @ CAR P. SO. FT. @ WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK j ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1V. c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE 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 R 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. $ 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 Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 12/7/95 API # 774-134-014 No. ' 13947 Jurisdiction La Quinta Owner Name William J. Cox & Sons Permit # No. 53585 Street Avenida Navarro Log # City La Quinta Zip 92253 Study Area 110 Tract # Lot # Square Footage 1257 Type of Development Single Family Residence No. of Units 1 Comments 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 ac-cessory 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 projectmay now be issued. I . Fees Paid By William J. Cox & Sons ;Telephone 21-378t'; _ Name on the check By Dolores A. Ballesteros' L, ` Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2;162.04 Check No. 5121 Signature Collector: Attach a copy of county or city plan check application form to district copy for all wai-ers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt" Copy - Accounting RECORDING REQUESTED BY 74676 CHICAGO TITLE COMPANY - y � MAIL To;tECEIVEC- FOR RECORD SAND WHEN RECORDED I''M - AT 2:4'0 O'CLOCK ( F WILLIAM J. COX I v P.O. BOX 967 PALM DESERT; CA. 92261 AUG 21 1995 It PA D ( Tlransle� Tax , / K JOHNSON Re<«eee n o��� Reeoras of Rimsice Courcy, Cafitoml C;0. ReOordelr Recorder ' n l _ _j " YA..,Fees$— Escrow No. 86774 -23 / order58$076 — 14 —�, SPACE ABOVE THIS UNE FOR RECORDERS USE p� 7� Assesaor's Parcel No: GILA NT DEED 774-134-014 -j TME UNDERSIGNED GRANTOR(S) DE DOCUMENTARY TRANSFER T. aunincorporated area 0` computed on the full value ¢f computed on the full value 1'0; FOR A VALUABLE CONSID RON BARCA, 1hCIS $17.05 City of the interest or property conveyed, or is s the value of licnsor encumbrances remaining at time of salt, and ERATION, receipt of which is hereby acknowledged, hereby GRANTS) to WILLIAM J. COX, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY r� i the following described real property in the x County of RIVERSIDE , State of California: LOT 4 IN'BLOCK 241 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 23. IN THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 20, PAGE 25 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. Dated July 30, 1995 STATE OF CALIFORNIA SS /RON BARCA COUNTY OF J before me, On a Notary Pablic in and fojsaid County and State, personally appeared personally known to me (or proved to me on the basis of satisfactory v evidence) to be the person(s) whose names) Is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same In his/her/their authorized capacity(ies), and that by his/her/their _ CORNELLa A. ELU$OR signature(s) on - t strument the person K, or the entity upon behalf of Z @ _ COMM. # 981692 which the pec nKa ed, executed the Instrument. z Notary Pubic - California SAN DIEGO COUNTY WITNESS my hand And official seal. My Comm. Expires DEC - 1996 gna U e'6f Notary v FOR NOTARY SEAL OR STAMP MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE: IF NO PARTY SO SHOWN, MAIL A3 DIRECTED ABOVE SAME AS ABOVE City, State & Zip . Name . Street Address . GDI-O3/07/94bk W77 Cer}ificai¢ of dccupancy �� Cify oF.Cre Quinia � Building and Safely Deparlmeni This Certificate issued pusuant to the requirements of Section, 109 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: 53-585 AVENIDA NAVARRO Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: '9510-056 Occupancy Group: R -3/U-1 Type of Construction: V, -N Land Use Zone: RC Owner of Building WILLIAM J. COX ` Address: 51-785 AVENIDA BERMUDAS City: LA QUINTA, CA 92253 By: `DANIEL P. CRAWFORD, JR.' Date: JUNE 27, 1996 Building -Official I POST IN A CONSPICUOUS PLACE