9510-057 (SFD)d
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. ,,, 1439.57 13date ' 5/31196
License # t Lic. Glass, ,
Exp.
Date 1 ^�` j SignatureofContracto�l0.,ft
\ .^^*_�",'
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 PTA?. i:trr-n') Policy No. 2?0S2A?iq�1
(This section need not 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 or
Code, I shall ,forthwith comply with thosre prbvisibns.
Date: P �"*�w'1 1 Applicant V ,a'��, 1 r °�
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject .an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, intarest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void. if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature (Owner/bent) Date__.........,
8
"`°'
BUILDING RERMIT
PERMITfji���
DATE . 12/ ;6fg�
VALUATION 5$ 0,035ACJ LOT d' 1 TRACT BL K. 12t
JOB SITE ADDRESS -765 AVENYDA 13ERIV IMM
APN 773-1$4-8D13
OWNER
CONTRACTOR
WfL.L,1AM J. COX & SONS+
WILLIAM J COX
66904) MUM RD.
51-765 AV;ENIDA BERIMUDA•S
PAL IVI DESERT CA 92261
L.A. QUINTA CA CA 92253
(614)251-3780 CAL# 1265
f619j25.1-3?1341
DESIGNERIENGINEER
USE OF PERMIT INGVE FAMILY DWELi.,.iNG
Permit does not include block wW1 or tv6l.
FEE DESCRIPTION
FEES
TRACT CON4)'.1'RUCTION 1.251.00 S—
PO12Ck1 PKfit . .143. 00 8F
GARAGE/CARPORT 504.00 S%
J
ESTMAT1L{dD OOS`1r OF COMS°i'.MUd."TdON
90,0315.40
PERMIT VER SUMMARY
DSPC) `1T 4250.00
PLAN CLiI:CK FEE 101(>41L` -?D9-318 S409.13
CONSTRUC I[ON 101-000.418-UOtI
U-)
MECHANICAL FEE 101-000-421-000 S47M
M
MECTKICAL FEE 101.4.0-420-040 $1.17.58
PIXTAMINO :FFE 101-000419-000 $127.54
STONG MOTION ME - RES1113 100-000-241-000 $8.04
Q� c,
GRADINO FEE .101-000423-000 520,00
`LLJ
1WF ASTRUC P.F FEE 22S -U()0 -X13 -?k12 $1,736.00
,
PRECISE PLAN 101.000-411-345 $25.003...
SUB -TOTAL CONSTRUCTION -AND PLAN CHECK {4:
r 53;128.25
LESS FRE-PALD FEES
-$2"100 '\
TOTAi. I}°ERM T FEW% DUE NOW
$2,1876.25
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs Q /
Underground Ducts
Forms & Footings 2 /8
Ducts
Slab Grade
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath or
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV LS
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 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 LateralPool
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 9M
Utility Notice (Perm)
COMMENTS:
LW
Tihf 4.4a a
78-495 CALLE - TAMPICO _ - LA. QUINTA, CALIFORNIA 92253 - (619) -777-7000
FAX' (q1 9) 777-7101
February 20, 1996
William J. Cox & Sons
P.O. Box 967
Palm Desert, CA 92260
Dear Mr. Cox:
.Please be advised of an address change for the following structure. The structure
formally addressed as 51-765 Avenida Bermudas, APN #773-184-013, lot '1 block 121,
will now be addressed.as 77-995 Calle Sinaloa.
Please note .this change and feel free to contact me if. I may be of further assistance.
Thank -you.
Sincerely,
BUILDING & S FETY DEPARTMENT
Kelly Tropple
Counter Technician
J
t meq.
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253.•,
y�. P.O.
78-105 C
Building
Address I !?r LA QUINTA,
. /' � � y t k r �>,��i.�,
Owner
LL'
Mailing
Address t/j `�o a l G e
City Zip Tel.
Contractor
.Address
City IZip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityIZip 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 rile 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 or 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 live hundred dollars (8500).
f7 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.)
I. 1 1, 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
FJ 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 (S100) 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 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 the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
BDx 1504 APPLICATION ONLY
ALLE ESTADO .
CALIFORNIA 92253
11LDING: TYPE CONST. OCC. GRP.
P. Number % 7 I / `•: `" t (' 13
/ '/ J j
gal Description 4, ` l mk
oject Description
Sq. Ft. No. No. Dw.
Size Stories Units
lew ❑ Add O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL > ��
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Reyr�Prop. Line
Side Street Setbac �frro Cert er Line
Side Setback fr m" ertyAL,'pe
FINAL DATE
NSPf68QR
I Q
Issued by:
Date" .JPermit %
\
Validated by:
�` An -
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IIST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. a
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL S0. FT.
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SP.KLR SYSTEM!
BAR SINK
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
WASHER(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,TEMlPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ t+/. c
SEWAGE DISPOSAL
SO.FT.GAR q 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 & 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be. Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/7/95
No. 13945 Jurisdiction
Owner Name William J. Cox & Sons
51765
No. 7-Qq5 Street "ZACLc_ l AL:1A
City La Quinta Tp 92253
Tract # Lot #
Type of Development Single Family Residence
Comments
APN # 773-184-013
La Quinta
Permit #
Log #
Study Area 112
Square Footage 1257
No. of Units I
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 permi-s and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. ,,
L'
Fees Paid By William J. Cox & Sons Telephone 2,<4-3780,
1 r -
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,162.04
Check No. 5136
Signature _8 1, Il A,�p�
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
.z