001080 (SOL)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned.for a period of 180 days.
•LICENSED CONTRACTORS 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 lull force
and effect.
License Class { i L Lic. Number 44 S ' (7
Date 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) o1 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 >
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): _ a•.r>.
0. lias owner o1 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 and Professions Code: The Contractor's Licelise
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 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.).
0 I, as owner of the property, 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. & P.C..(Attached Certificate).
Date r 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
0 Certified copy is hereby furnished.
.0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F, MI) Solar ' Transition/Desert
ADDRESS 605 Me 1 Avenue
CITY/COMMUNITY/STATE/ZIP Palm Springs, CA 92262
JOB SITE ADDRESSISPACE
52•-900 Avenida Diaz
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
773
PAG
31
PRC
00E
I C
TWN
RNG..
SE
S
TRACT
LOT
1C
MOD
SB
..
TRACT NAME "
OWNER NAME (L. F. MI)
Steve Nelson
CONTRACTOR -FIRM NAME'
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/IIP '
above
PHONE •LICNC
325-647'51
�
1
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE II
TOTAL,•
LICNC
USE OF PERMIT
Solar Collector
Bl
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD1..
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) It, 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.
Date Applicant
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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 thereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, AA 2, Sec341, Title B,
C.A.C.)
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 that there is a construction lending agency for the performance'
of.the work for which this permit is issued .(Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
_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. I
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state 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 properly for which I have applied for this permit for.the purpose of making inspections. .
t t 1, .. c
Signature of Applicant or Agent Date r'
x 711,1 "-Tl _ •-, V
Print Applicant/Agent Name ( t
APPUPRMT
DATE
12-YQ-Q4 PLUMIIING
Permit to install a solar collector
And tank as per
approved plans.
Plumbing Fee
15.00
J
l
TOTAL,•
15.00
BLDG. DEPT. VALUATION 2, 500. 00
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Figs &.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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
t3 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.
PP/I
,
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
290 Bonding
30 Fixtures
31 Service
32 Final
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
7
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO FT. ®
POR SQ FT ®
GAR. SO. FT. ®
CAR P. $0. FT. ®
WALL 80. Ff. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWEROUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
PLANNING DEPT
FLOOR DRAIN
MECHANICAL FEES
$
WATER SOFTENER
VENTSYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ELECTRICAL FEE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
$
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT ® ¢.
BATH TUB
SQ. FT. ® ¢
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO.FT.RESID ®11/44
SEWAGE DISPOSAL
SQ.Ff.GAR ® 3/4t.
HOUSE SEWER
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
MICRO FILM FEE
Cop
$
ROAD DEPT
MECH. FEE
Dbl
$
PLANNING DEPT
PL. CK. FEE
LAND USE
$
CONSTRUCTION FEE
Dbl
$
ELECTRICAL FEE
DbI
$
SMI FEE
$
PLUMBING FEE
Dbl
$ /s
TOTAL FEES
M.O.Lj N.C.Lj CASH
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
T LL
SEWER DISTRICT
FORM 284.58 (REV. 8179)
JOB ADDRESS
52 - goa qv�v� o>g Diez
USE OF PERMIT
SMA4?- Dirviz� ulama �r
PLAN NO. PLAN CHECKER
1,7—(f
DATE
NOT APPROVED
PLAN CHECK
PLUMBING
ELECTRICAL
STRUCTURAL
FIRE MARSHAL
$ l� 00 AUDIT
CHECK ❑ I C.R.T.
P
COMMUNITY
Lf - 0u;t—r p—
VALUATION
ao.`l*
DATE
DATE
APPROVED
OWNER
S(bvc N�1��
F.C.C. GROUP TYPE
SUPP. TO PERMIT
CLEARANCE REG'D
❑
GRADING
❑
ROAD DEPT
❑
HEALTH DEPT
❑
PLANNING DEPT
❑
LAND USE
REMARKS: S C9 (-0: cz Ca l L i -L~ (3 !)w,,' '4 Fa *.k. l-e'o
I
JOB
SOLAR kTRANSITION "OF THE. DESERT" SHEET NO. OF
605 Mel Avenue
II PALM SPRINGS, CALIFORNIA 92262 CALCULATED BY DATE 2- -7, S4
(619) 325-6475
CHECKED BY DATE
SCALE NLrr
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