11-0414 (SOL)IIIIIII VIII III VIII (III 15
IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000414
Property Address: 54240 AFFIRMED CT
APN: 767-320-999-301 -32879 -
Application description: SOLAR
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 10000
T&�1440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DARGATZ RODNEY
54240 AFFIRMED
LA QUINTA, CA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/14/11
L
92253
Contractor: V a
Applicant: Architect or Engineer: SALVESON, KENT E.
28391 AVENIDA LA MANC %j�{�
SAN JUAN CAPISTRANO, 679"1/Ig 1
(949)291-7393 � 2011
�Ir Lic. No.: 777413
LICENSED CONTRACTO DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under visions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professio , and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice n CI ss: C20 CA�ontractor:
2 e : 777413 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate _ 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
WNER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EEEEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work fo hich this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become su t to the is compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become s o the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3,700 of the Labor Code, I s om ly with those provisions.
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).: te: 7 I plicant:
(_ 1 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 WARNING: FAILURE TO SECURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at.whose request and for
pursuant to the Contractors' State License Law.)• whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 Address: kr
LQPERMIT
of La Ouinta, 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 wor not commenced
within 180 days from date of issuance of such permit, or cessation of w for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is r t. I agree to comply with all
city and county ordinances and state laws relating to building construction eby authorize representatives
of this you y to a er upon the above-mentioned property for inspec ses.
I_rd/te/ y Si ture (Applicant or Agent):
Application Number . . . . . 11-00000414
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
30.00 Plan Check Fee
7.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
12/11/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 7.5000
----------------------------------------------------------------------------
EA ELEC PWR APP >1 TO <=10
15.00
Permit
SOLAR PERMIT
Additional desc .
Permit Fee . . . .
25.50 Plan Check Fee
6.38
Issue Date
Valuation . . .
. 1.0000
Expiration Date
12/11/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000
EA SOLAR COLLECTOR < 1000
4.50
2.00 3.0000
EA SOLAR EQUIP MISCELLANEOUS
6.00
----------------------------------------------------------------------------
Special Notes and Comments -
12.8kW SOLAR ARRAY -
(56) 230 WATT
PANELS W/ (2) 7000W SUNNY
BOY INVERTERS
[985SF] 2010 CALIFORNIA
ELECTRICAL CODE.
June 13, 2011 4:41:45
PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-----------------
Due
----------
Permit Fee Total
------------------------------
55.50 .00 .00
55.50
Plan Check Total
13.88 .00 .00
13.88
Other Fee Total
1.00 .00 .00
1.00
Grand Total
70.38 .00 .00
70.38
LQPERMIT
Bin #
Qty of La Quints
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: q1; q
Owner's Name:
A. P. Number: ff
Address: il 2 U �
Legal Description:
Contractor:/
Address: Z g 3 �'� �� � ��cr �%%
City, ST, Zip:2 j
Al
t z. .;.;•.:;..::afi::;>::z;;::• :, >:
Telephone: / / �
Project Description:
City, ST, Zip:
Telephone: r / %f
1417 I,/
State Lic. # : 77 7 'Y/3 City Lic.SVMW
Arch., Engr., Designer: 100 0-C `,
SAW
Z*4o W 6W
Address:
City., ST, Zip:
Telephone:
State Lic. #
;ass;;:;:. :w•:s :":3;/ °
..iJ.i: .c��'%•j: Y$sErJ° .4j:G:ti:�sr;:
?'? rv'
<�. f
Construction Type: Occupan
Project type(circle one): New Ad Xter Repair Demo
Name of Contact Person:
Sq. Ft.:
# tones: '# Units:
Telephone # of Contact Person: 3 '13
Estimated Value of P oject:
APPLICANT: DO NOT WRITE BELOW THIS L
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
em
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
o+
Truss Calcs.
Called Contact Person5
S 4011
Plan Check Balance .
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted 11 i)
Mechanical
Grading plan
2" Review, ready fo o ecti s/issue 5 JKJ
Electrical
���
ilia.
Subcontactor List
Called Contact Person 5,�
Plumbing
�►+
Grant Deed
Plans picked up
S.M.I.
"—
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for correctio ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
r
Total Permit Fees
5 51%9- 5"A QCz 11,V+T e -vv )
5 1q`owl- `4* " * C~11
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