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BSOL2016-0136LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lic sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 oft Business and Professions Code, and my License is in full force and effect. License Class: License No.: 661434 Date:// ---2— y-- 4� Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: (_) 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury 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 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 and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115206 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, I should become subject to the workers' compensation provisions c f Secti' on 37 of the Labor Code, l shall forthwith comply with those provisions. _2 Date: b — Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this 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., the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws elating to building construction, and hereby authorize representatives of this city to a er upon the above-mentioned property for inspection purposes. , f Date: -:: '24— C�v Signature (Applicant or Agent) 78-495 CALLE TAMPICO D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT D 11/23/2016 Application Number: BSOL2016-0136 Owner: ►� Property Address: 54045 OAK HILL SUNRISE DESERT PARTNER APN: 775061049 300 EAGLE DANCE CIR �-- Application Description: PGA WEST / POOL 13A / ROOFTOP THERMAL POOL HEATING SYSTEM PALM DESERT, CA 92253 4 Property Zoning:cc j Application Valuation: $14,980.00 N c J— QO Applicant: Contractor:O MOHR POWER SOLAR INC DBA 21ST CENTURY SO MOHR POWER SOLAR INC 21ST,:?JNTU& 1452 POMONA ROAD 1452 POMONA ROAD 4 U CORONA, CA 92882 CORONA, CA 92882 Z Q (951)736-2000 � ® Llc. No.: 661434 --------------------------------------------------------------------------------------------- a LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lic sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 oft Business and Professions Code, and my License is in full force and effect. License Class: License No.: 661434 Date:// ---2— y-- 4� Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: (_) 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury 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 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 and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115206 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, I should become subject to the workers' compensation provisions c f Secti' on 37 of the Labor Code, l shall forthwith comply with those provisions. _2 Date: b — Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this 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., the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws elating to building construction, and hereby authorize representatives of this city to a er upon the above-mentioned property for inspection purposes. , f Date: -:: '24— C�v Signature (Applicant or Agent) Application Number: BSOL2016-0136 Property Address: 54045 OAK HILL APN: 775061049 Application Description: PGA WEST / POOL 13A / ROOFTOP THERMAL POOL HEATING SYSTEM Property Zoning: Application Valuation: $14,980.00 S Date: 11/23/2016 Owner: SUNRISE DESERT PARTNERS 300 EAGLE DANCE CIR _ PALM DESERT, CA 92253 Applicant: Contractor: MOHR POWER SOLAR INC DBA 21ST CENTURY SO MOHR POWER SOLAR INC DBA 21ST CENTURY SO 1452 POMONA ROAD 1452 POMONA ROAD , CORONA, CA 92882 CORONA, CA 92882 (951)736-2000 Llc. No.: 661434 --------------------------------------------------------------------------------------------- Detail: ROOFTOP SOLAR POOL WATER HEATING SYSTEM MOUNTED ATOP AN EXISTING PATIO COVER STRUCTURE. POOL 13A. 550 SF COLLECTOR [(11) HC - 50 PANELS] AND PIPING TO EXISTING POOL PLUMBING + HELIOMATIC 5000 240V ELECTRIONIC CONTROLLER W/ BOOSTER PUMP. THIS PERMIT DOES NOT INCLUDE ADDITIONAL OR ALTERATION TO EXISTING PRIMARY POOL PUMP. ALL PIPING TO BE INSPECTED PRIOR TO BACKFILL. STRUCTURAL APPROVAL GRANTED PER BH. 2013 CALIFORNIA BUILDING CODES. FINANCIAL •R • DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PV SYSTEM MISC EQUIPMENT 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT PV SYSTEM MISC EQUIPMENT PC 101-0000-42600 0 $25.33 Total Paid for ELECTRICAL: $50.66 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT SOLAR THERMAL 101-0000-42401 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT SOLAR THERMAL PC 101-0000-42600 0 $25.33 Total Paid for PLUMBING FEES: $50.66 Bin # City of La QuInta Building 8T Safety Division Permit #I 78-495 Calle Tampico � L ����� 3� La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Projec t Address: - ({ —cl--> © l �1� Owner's Namc: �A-. 41L_ A. P. Number: Address: Legal Description: City, ST, Zip: 1 U I,,, 014 baa s Contractor: kTelephone: �L 7 / ��3 Address: w�. (--�om3.oA Project Description: City_ ST� %fes , Zip: e�l�t.S A G 5b,-4:3- I /v . 1" n IGY to—I 0 th TeleP hone: h S 3 /. - S •s v G A-T State Lie. # : 1.14 3 City Lie. Arch.,'Engr., Designer: Address: City, ST, Zip: Telephone: cY- Con trottton Type: Occupancy: State Lie- # ProjecttYPe (circlele one), Add'n Alter Repair. Demo. Name of Contact Person: �d �K —4r jA JQe Z—. Sq. Ft_: ��n' # Stories: t #Units: Telephone # of Contact Person: 95 / 7 3e- aG')0b Estimated Value of Project: f APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Rcq'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plin Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Revicw, ready for corrections/issue Electrical SubcontaetorList Called Contact Person Plumbing Grant Deed Plans picked up II.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fecs, Total Permit Fees