SOLAR 0091PERMIT APPLICATION
City of La Ouinta
• 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.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 the permit is for one hundred (S100) o, less. I certily that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force issued, I shall not employany person inanymannerso asto become subject to the Workers'Compensation Laws of
and effect. California.
License Class Lic. Number
Dale Contractor
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 file 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 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption- Any violation of Section 70315 by any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500.):
0 I, as owner of the properly, 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 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 improvemnt is sold within oneyear of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale;),
0 I, as owner of the properly, am exculsively contracting with licensed contractors to construct 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.).
0 1 am exempt under Sec. B 8 P.C. (Attached Certificate).
Dale Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.),
Policy No. Company
I-
13 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Dale - Applicant`-__ l -
APPLICANT NAME (L, F. MI) r
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ADDRESS /ri f,
C1 T Y ICOMIHUN ITYISTA TE/Z I P
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
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TRACT LOT
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TRACT NAME
OWNER NAME (L, F, MI)
CONTRACTOWPIRr�iWeArE /
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ADDRESS,
CITY/COMMUNITY/STATE/ZIP i
PHONE N
LICNC y
ARC/ENG FIRM NAME
ADDRESS
CITY /COMMUNITY /S TA T E/Z I P
PHONE N
LICNC X
USE OF PERMIT
BL
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FSB
SSB SSB
RSB
OFC
ZONE ORD M
LOT SZ
END
SIDE
NOTICE TO APPLICANT: If, alter 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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I h e reby certify that no excavation five (5) o r mare feet in depth inle wh I ch a persc n is req uired to de stand, will be
made in connection with work authorized by this permit, and thatno building structure, scaffolding, lalsework,or
de[nolition or dismantling thereof, will be more thait thirty-six (36) lest high. (Chap 32 Grp 2, Art2, Sec341, Tille 8,
6JAC.1
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm [hat there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Hama
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 county to enter upon the above-mentioned property for inspection purposes
Signature of Applicant or Agent Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate that
the information given is correct, I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a -representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections-
Signature
nspections
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT '� ''' DATE
RECEIVED
I RX NX
Ell W
MAN ei 0 003
City Of La Quanta
TOTAL .
FEE
VALUATION
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE IflSPEC "R
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
I
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.
❑
NPON ADDITIONAL INFORMATION
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
P1L P�
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME