BELC2016-0063LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License Class: C-7 /Licee—nseeNNo.: 478543
�Da ee �� / �� Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she 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).:.
(1 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 and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
(1 I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
(760)328-6778
Llc. No.: 478543
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.
'g""Thave 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 and policy number are:
Carrier:_ Policy Number: _
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.
Date: /^ / f- /f_ Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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., the owner, and the applicant, .each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date:7-- Z`—Signature (Applicant or Agent):
`
4aw
VOICE (760) 777-7125
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
'
BUILDING PERMIT
Date: 7/19/2016
Application Number: BELC2016-0063
Property Address:- ~ 47985 MIRAFLORES BLVD
n
D
Owner:
MIRAFLORES COMMUNITY ASSN
APN: 600320060
"`
73550 ALESSANDRO ST
Application Description: TIME WARNER CABLE / PEDESTAL
JUL 19 2016
PALM DESERT, CA 0
Property Zoning:
Application Valuation: $1,200.00
CITyOFW QUINTA
COMMUNITypEVELOPAIE,VTDcPpRTMENT
Applicant:
Contractor:
COCHRAN COMMUNICATION CONSTRUCTION INC
COCHRAN COMMUNICATION CONSTRUCTION INC
36630 CATHEDRAL CANYON DRIVE
36630 CATHEDRAL CANYON DRIVE
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234 ,
LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License Class: C-7 /Licee—nseeNNo.: 478543
�Da ee �� / �� Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she 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).:.
(1 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 and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
(1 I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
(760)328-6778
Llc. No.: 478543
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.
'g""Thave 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 and policy number are:
Carrier:_ Policy Number: _
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.
Date: /^ / f- /f_ Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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., the owner, and the applicant, .each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date:7-- Z`—Signature (Applicant or Agent):
DESCRIPTION.
FINANCIAL INFORMATION
TY AMOUNT PAID PAID DATE
ACCOUNT'Flo
BSAS SB1473 FEE
101-0000-20306
$1.00 $1.00 7/19/16
PAID'BY
METHOD
RECEIPT # CHECK # CLTD BY
COCHRAN COMMUNICATION CONSTRUC
CHECK
R17227 11015 RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION. BSA: $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SERVICES
101-0000-42403
0
$24.17
$24.17
7/19/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
COCHRAN COMMUNICATION CONSTRUC
CHECK
R17227
11015
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SERVICES PC
101-0000-42600
0
$12.09
$12.09
7/19/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
COCHRAN COMMUNICATION CONSTRUC
CHECK
R17227
11015
RSE
Total Paid for ELECTRICAL: $36.26 $36.26
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
7/19/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
COCHRAN COMMUNICATION CONSTRUC
CHECK
R17227
11015-
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
Description: TIME WARNER CABLE / PEDESTAL
CONDITIONS
Type: ELECTRICAL
Subtype:
Status: APPROVED
Applied: 7/19/2016 RSE
Approved: 7/19/2016 RSE
Parcel No: 600320060 Site Address: 47985 MIRAFLORES BLVD LA QUINTA,CA 92253
Subdivision: TR 28601-1
Block: 999
Lot: 9999
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $1,200.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: 100AMP METER AND PEDESTAL. 2013 CALIFORNIA BUILDING CODES.
COCHRAN COMMUNICATION
CONSTRUCTION INC
CHRONOLOGY
CONDITIONS
STATE
21P
PHONE
FAX
EMAIL
„NAMI: TYPE
" NAME
ADDRESSI
CONTACTS
p
CITY
APPLICANT
COCHRAN COMMUNICATION
CONSTRUCTION INC
36630 CATHEDRAL
CANYON DRIVE
CATHEDRAL
CITY
CA
92234
CONTRACTOR
COCHRAN COMMUNICATION
CONSTRUCTION INC
36630. CATHEDRAL
CANYON DRIVE
CATHEDRAL
CITY
CA
92234
;
OWNER
MIRAFLORES COMMUNITY ASSN
73550 ALESSANDRO ST
PALM DESERT
CA
0
FINANCIAL INFORMATION
Printed: Tuesday, July 19, 2016 4:17:38 PM 1 of 2 J
SYSTEiv1S
INSPECTIONS
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
Printed: Tuesday, July 19, 2016 4:17:38 PM 2 of 2 C ,
SYSTEh1S
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY -
_
BY
COCHRAN .
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
7/19/16
R17227
11015
CHECK
COMMUNICATION
RSE
CONSTRUC
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
COCHRAN
SERVICES
101-0000-42403
0
$24.17
$24.17
7/19/16
R17227
.11015
CHECK
COMMUNICATION
RSE
CONSTRUC
COCHRAN
SERVICES PC-
101-0000-42600
0
$12.09
$12.09
7/19/16
R17227
11015
CHECK
COMMUNICATION
RSE
CONSTRUC
Total Paid for ELECTRICAL: $36.26 $36.26
COCHRAN
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
7/19/16
R17227
11015
CHECK
COMMUNICATION
RSE
CONSTRUC
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:
INSPECTIONS
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
Printed: Tuesday, July 19, 2016 4:17:38 PM 2 of 2 C ,
SYSTEh1S
Bin #
Permit #f
Project Address: y 7 9
A. P. Number:
City of La Q uin to
Building 8r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 : (760) 777-7012
Building Permit Application and Tracking Sheet
A1144 l"45 Owner's Name: W- C (,,,J AX-JOL LC,
Pr, vt,)
Address: y,77ZS— 91)ft
Legal Description: r I R'14 i�(R a9V
City, ST, Zip: tom, jC S Ez —
Contractor: ^
C.B
Telephone:
hone:
Address: 3(o� (3 V C4%p 9.0 v G'yft(r„)r� PA
Project Description: ae �^� Fell,
CItY, ST, Zip:
e� (�
�1.�/J�;
Telephone: & 3 6
7 7 �8
...................:.::.::::::::::::::::.::::::.
State Lic. #.: �i%�s—y
City Lic. #:
Arch., Engr., Designer: .
Address:
City, ST, Zip:
Telephone-
_
an
Occupancy:
e: cY:
0 ns(ruction TYP
State Lic. #
Project nP circle one): • Ne w Add'n Alter Repairair Demo
Name of Contact Person:
Sq. Ft_:
# Stories:
# Units:
Telephone #'of Contact Person:
Estimated Value of Project:
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACMG . PERMIT FEES
Plan Sets
Plan Check submitted
Item
'Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready foreorreclionsfissue
Electrical
Subcontactor List
Called Contact Person,
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
INHOUSE:-
'rd Review, ready for eorreetionsCssuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
�'YI