BLDG (9601-029)INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
s &Footings
Ducts
Grade
E
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
Equipment Location
Underground Electric
Underground Plbg. Test
Final /
Gas Piping
PLUMBING APPROV S
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:
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. 14-;9,—, B it 310o
License # Lic. Class Exp. Date
Date 1 Signatureof Contractor, Ti-1Q.M.o
r..a-..--...��...,►
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 , .. , .... Policy No.
(This section need not be completed if the permit valuation is'fo� $1 • .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 forlhwith comply with t4osq provi ions5,
Date: r Applicant 1
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 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 wcrk 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 authori representatives of this City to enter upon the
above-mentioned property foi ins action purpose .
fSigriature (Owner/Ager Dale '
i f
ALcx
BUILDING PERMIT
PERMIT;
�+rlar2,
DATE
VALUATION $400.0( LOT
TRACT
JOB SITE ADDRESS , , (
I APN
,•
OWNER
CONTRACTOR
WILLIAM J COX & SONS
WILLIAM J. CO.K & SONS
6611*01)(11ON RD
669W%iILWN Ria.
PALM DESERT CA 02261
PALM DP.SFWr CA 92261
(619)1.51-37130 CBL# 1265
614 r2 51-37RO
DESIGNER/ENGINEER
USE OFPERMI`;ENI.RAL BLU1,i)1NG
Z 11. of 4' lush prdett Work wv l
FEE DESCRIPTION
FEES
d F 1. WALL 2S.00 LF
F.STi1UTED COST OF CONSTRUMOY
400.00
PERlMI I' F K SUMMARY
CONSTRUCTION Mrs 1014000-418-000 $15.00
SUIS-`1(YrAL CONSTRUCTION AND PLAN CHUCK
$15.00
/ LESS PRE -PAID PEES
$0.00
�,D q AL PERMIT FEKS DUt,' NOW
S14.00
✓qN 6 9 1
996
ey
RECEIPT Q
BY
DATE FINALED
INSPECTOR
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Fi
Ai PLL
DATE