PLBG (9808-017) + SOL (001551)53280 Avenida Martinez
9808-017
001551
LICENSED CONTRACTOR 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
5t37333 AB i Ri3ilx 8
,Date—; Signature of Contracrnr5 »- -
1 16
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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.
Ii1 ve and will maintain workers' compensation insurance, as required by
c '0 37 0 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.
`s'I'ATtl rIP,4T IID?r":.i-911
(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' coppensation-previsions o Section 3700 of the Labor
Code, I sh II forth'th comply with those provisions
Date: t Applicant
I '
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, 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 forinspection purpo eS.
"C?
Signature (Owner/Agent) —•r_ Date
CONTROL#
BUILDING PERMIT PERMI980M
f'17
DATE VALUATION S1(0i) (K) LOT TRACT i C
.5_98 ( v
ADDRESS-, .3-280 A't- N10A 1AX i .iNEZ JOB SITE
APN .
\
OWNER
CONTRACTOR / DESIGNER / ENGINEER
53.21190 MARMNEZ
P.O. BOX 1555
LA QUWI'A CA' 92253
LA QUIWA CA 9253
f A)140-2726 MIA 25:11i
USE OF PERMIT
S17[)#'fC ABANT)ONMEN>n AND SEWER CONNECTION
d A LUA'I'ION I,w 00 1. r,
.;:' ' ' 1'3a ` .•w. Com'`€' L•3l F:C1 4 ':;:;C" ':!,'„ T
I,titl;'..1.'i)
PERMIT FER Stmt INC kR
PLUkMTkINff I;EE -- 4FWV.I2 1101 -OW -4f9-000 S30 rel
rT-t VIY}'i AL ('ONS MUC710N AND PIAN CI IECK
Clio 00
LEMS PRI. -PAW H PS
50.00
l4yT','1T, f'#:k11 UC k'"Mi 0UH: NtlW
530.00
RECEIPT Z
DATE
BY DATE.FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
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 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 Pibg. 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 Lateral %
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Applances
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
r
Final
Maty Notice (Perm)
Final
COMMENTS:
A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
Q Meter Surcharge
,R Sanitation Capacity Charge % Li
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL. $ Z
Remarks:
T'Gopy to:
Cash . Water Service
Check ✓ % :f::.<>
MoneyJ
Order Cashier
C 43e (11189)
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
1/ i l ll JJl L
. i
Date:
Address:
0 f3ax
^ 1 r.
f A L ul/u /N CA
ft&✓ _ 3
' Account No.
(IJi J 1-14-,
(o-77 0 • i
Lot(s)
Tract
Service Address
3 °D
v'f-- t!
ML1,10 Nl:r7
A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
Q Meter Surcharge
,R Sanitation Capacity Charge % Li
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL. $ Z
Remarks:
T'Gopy to:
Cash . Water Service
Check ✓ % :f::.<>
MoneyJ
Order Cashier
C 43e (11189)
•W
O
Z
2502 Morongo Trail
Palm Springs, CA 92264
(619)327-8859
N2 1034!
SOLD TO
14 f Le' -V--
SHIPPED SHIPPED TO
STREET NO. STATE
r
STREET NO.
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CITY STATE ZIP
CITY STATE IP
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CUSTOMER ORDER
SA^ESMAN
TERMS
FIO.B.
DATE
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PAYMENT DUE UPON RECEIPT
•4 64
A'
P.O. BOX 1504 N o . 001551
Building 78-105 CALLE ESTADO
Address 5 %1 *an_ ;r- - LA QUINTA, CALIFORNIA 92253
Owner.
Thcom ga&k" BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address
A.P. Number
City Zip Tel.
T,* f%vJE±a Q27571 Cazr A-11WIR Legal Description
Contractor Project Description &)Ur not mat= systilm
U.S. »Wi iii
Address .
City Zip Tela
Nam slomix 92262
State Lic. City
& Classif. 467850 Lic. # Sq. Ft. No. No_ Dw.
Arch., Engr.,. ..
Size Stories Units
Designer New iY1 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
n LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thah'l,am licensed under provisions of Chapter'9 (commencing with Section
7000) of Division 3 offfhe-B siness and Pofe ssions Code, and my license is in full force and
effect. . . ./ ' ._
--
SIGNATURE (. - .../., _ ice_" ""'.'.e1 DATE _
OWNER -BUILDER DECLARATION Estimated Valuation
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,ts licensed pursuant to
PERMIT ' - AMOUNT
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
Plan Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.Professions
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who .
Mech.
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
Electrical'
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.)
Plumbing
❑ 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
S•M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I.am exempt under Sec. B. ti P:C. for this reason
Grading
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. O 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 performanceroI the wprk for which,lhis_permit is issued, I shall not
employ any person in any manner eo as torbecome`subject to the 1Norkers'-Compensation
Laws of California. qy
Date Owner ,,f' 1
NOTICE TO APPLICANT: If, afterl'malr g° this Certificate of Exemption you should become
subject to the Workers' Compensatiort, provisions of the Labor Code, you must forthwithi
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 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 applica'n '' 1 . +'1' .- Date
Mailing Address
City, State, Zip
HARD COPYI
Driveway Enc
Infrastructure
TOTAL 20.01)
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.. Line
Side Street Setback from Centee Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Per -nit
Validated by:
Validation:
A 1 4 9 1 6 7 cC..00 Sl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT, ®
CAR P. SO. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR 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.
TEMPJUSE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATEq OUTPUT, B.T.U.
SQ. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SQ.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
s
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL
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SUNBURST RECIRCULATING SYSTEM
General. Specifications
COLLECTORS DIFFERENTIAL CONTROLLER
e Size
4'xWor4'x 10'
• Absorber Surface
Black Paint or Black Chrome
• Absorber Material
All -Copper
• Features
Fully Insulated, All -Aluminum
Enclosure
Low Iron Solar Glass
Easy Hook-up Unions
• Warranty
Full 5 Year
Additional 5 Year Limited
STANDARD STORAGE TANK
• Model: MS80RF3
• Capacity: 80 Gallons
• Approx. R Factor: R12
• OA Diameter: 29"
OA Height: 60"
• WARRANTY: 3. Years
Note: Equivalent tanks maybe
substituted according to availability.
Other manufacturers' warranties
may vary.
• Model: CM30
• AC In (50160 Hz)
105-13OV, 7AA Max
• Differential Output Power
115V, 1/3 HP., 7.2A.
• Adjustable "ON" Differential
8°-24°F
• "OFF" Differential
4°F
• Warranty
1. Year Full
Additional 4 Year Limited
CIRCULATOR
• Model: UP15-18SU
• Operation
115VAC, 65 W. 60 Hz, .56A,
'/,s HP, 2865 RPM
Capacitor: 8.Omf/180V
• Maximum System Pressure
142 PSI
Maximum Fluid Temperature
2300 F
• Warranty
Full 18 Months
SUNB_UR.ST solaw
mvision
ACRO Energy Corporation 0 0 eo..9o.Eft GrVaj.G95ON.416i654}al:.:c. c.co,ew-Ms,
SUNBURST- RECIRCULATING SYSTEM
The SUNBURST Recirculating System provides excellent protection in areas where
freezing conditions seldom occur. During solar efficient periods, the differential
temperature controller activates the circulator causing cold water to be drawn
from the bottom of the storage tank and circulated through the collectors. At night
the system stops circulating. When freezing conditions .occur, however, the
controller automatically "recirculates" warm water from the storage tank through
the collectors.
COLLECTORS
4' x 8' or 4' x 10'
All -Copper Absorber
All Aluminum Enclosure
STORAGE TANK
Model MS80RF3
80 Gallon Capacity
WARRANTIES
Collectors: Full 5 Years +
Limited 5 Years
Tank: Full 3 Years
Solar
SUNBURST Division
ACRO Energy Corporation . o..o.•.00MOW CAUM*OMM. +woUCA.O a. -MI
J
THE' EMPIRE COLLECTOR SERIES.
GLASS GLAZED SOLAR COLLECTORS
SPECIFICATION SHEET
NlodWs EMC and EMB
APPLICATIONS
Pool and Spa Heating • Domestic Water Heating • Space, Heating and Cooling • Industrial Process Pre -Heating
FEATURES
SUNBURST REPUTATION: A major solar manufacturer since 1974. SUNBURST collectors provide the contractor
total design freedom, easy installation and excellent performance.
LOW COST: Efficient production methods provide top quality, low cost and maximum heat collected per dollar invested.
SUNBURST WARRANTY: SUNBURST's extended warranty fully qualifies for solar tax credits. SUNBURST's net-
work of Authorized Service Centers guarantees a quick,_ professional solution to any possible warranty situation.
METAL ABSORBER PLATE: High thermal conductivity. Invulnerable to ultraviolet degradation.
COPPER WATERWAYS: Perfectly compatible with pool, spa and domestic water — Identical to copper waterways
in natural gas heaters.
GLAZED BOX: Patented, fully insulated aluminum box with attractive dark bronze finish.
DURABLE GLAZING: SUNBURST's standard -line collectors are equipped with a strong, tempered, high transmit-
ious to ultraviolet degradation, and brings the beauty and permanence of
tance solar glass. The glazing is impery
glass to your project.
CERTIFICATION: Tested to ASHRAE 93.77. Approved by the City of Los Angeles. Listed by I.A.P.M.O., T:I.P.S.E.
(California Energy Commission), Arizona Energy Commission, State of New Mexico, HUD and F.H.A. Certified by ARI.
SUN,BURST
Solar Division
ACRO Energy Corporation
P. O. Box 490. Elk Grove, CA 95624. (916) 685-8943 • In CA: (800) 852-7661
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