SOL (001363)53820 Avenida Martinez
001363
APPLICANT NAME (L, F. MI);nari= InSt:al.lation
i
PERMIT APPLICATION
City of La
Duinta
Department of Building
and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if -
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) ot'Division 3 of the Business and Professions Code, and my license is in full force
issued: I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date r• • • - ' -- Contractor ' J - w
NOTICE TO APPLICANT: If,'after making this Certificate of Exemption, you should become subject to the:Workers' -
;
OWNER•BUILDEf1 DECLARATION: I hereby- affirm that I am exempt from the Contractor's License'Law for•the -
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shale-!
be deemed revoked. '
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
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he, is licensed pursuant to the provisions of the Contractors License.Law
01 hereby certify'thatnoexcavation five (5)ormore feet indepth into which aperson isrequiredtodescend, will be
(Chapter 9 (commencing with section. 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by'this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant.for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z:Ar1.2, Sec341,Title8, '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): -
C.A.C.) - r •s+.a
O I: as owner of the property,. or my, employees with wages as their sole compensation, will do the work, and the.
p As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or.
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through his•own employees, provided that such improvements are not intended or offered for sale. If, however,Ahe
0 Division of Industrial Safety Permit No.
building or improvemni is sold within one year of completion, the owner -builder will havetheburden ofproving that
Date Applicant'
he did not build or improve for the purpose of sale.)..
CONSTRUCTION LENDING AGENCY: I hereby:aflirm that there is a construction lending agency for the performance
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
END SIDE• '
Contractor's License Law.). _
Lender's Address s
0 1 am. exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read.this application and state that the.above information is correct. I agree to comply with all
Date" Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
.
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. ora
'
certificate,'of Workers' Compensation Insurance , or a certified copy thereof'(Sec. 3800. Lab. C.y.
Signaiure of Applicant or Agent Date
Policy No. Company
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that %
0. Certified copy is hereby furnished. •?.
:•0
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling A:-
0Certified copy is filed with the City Building Inspection Department or City Department.` '
construction, and authorize a'representative of the City of La Ouinta Department of.Building and Safety to enter
Date Applicant
upon the property.for which I have applied fp,this permit for the purpose of making inspections. _
V
Signature of Applicant or Agent Date
APPLICANT NAME (L, F. MI);nari= InSt:al.lation
ADDRESS
2770 S. Harbor Blvd. #A
CITY/COMMUNITY/STATE/ZIP '
Santa Ana, CA 92704
JOB SITE ADDRESS/SPACE 53-820 Avenida Martinez
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
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LOT
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TRACT NAME
OWNER NAME (L. F. MI) " .•
CONTRACTOR -FIRM NAME - -
Awlicant:
ADDRESS
abwe •-
we
CITY/COMMUNITY/STATE/ZIP '
above
PHONE a
714 966-2128
LICNC • -
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC •
'
USE OF PERMIT
solar Water Heatj= Syaim
BL
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F$8
SSB
SSB' RSB
OFC.'.
• ZONE,ORD .. ;
- LOT SZ
,
END SIDE• '
Print Applicant/Agent Name
APPL/PRMT DATE
5-2-85 PLtm iNG.
Permt . to install a solar hot water system
as per approved plans.
Plirbing Fee 20.00
TOTAL
20.00
A 0 9 0 1
BLDG. DEPT.
5 _ 2
VALUATION 5,200.00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NO
ADDITIONAL INFORMATION
l
Sv / e%z— 7,/
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath
12 :Internal Lath
12A Drywall '
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal.
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final