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BSOL2015-015078-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: 1 4 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BSOL2015-0150 53810 AVENIDA MENDOZA 774173004 5.23kW PV SYSTEM - (16) 327W PANELS/(1) INVERTER $20,928.00 Applicant: SMART ENERGY SOLAR INC 1641 COMMERCE STREET CORONA, CA 92880 LICENSED CONTRACTOR'S DECLARATION . I hereby affirm under penalty of perjury 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 full force and effect. License Class: C46 License No.: 990049 Date/?-3Contractor OW,PtER-BU ER DECLARATION I hereby affirm under penalty,0 pe ry that I am exempt from the Contractor's State License Law for the followin son (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 ) 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 Na Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: LETICIA LOZA 53810 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: SMART ENERGY SOLAR INC 1641 COMMERCE STREET CORONA, CA 92880 (951)273-9595 Llc. No.: 990049 Date: 9/3/2015 oak . 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 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:— Policy Number: _ 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, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date [,- 3 S Applic WARNING: FAILURE TO SECU WORS' COMPENSATION COVERAGE IS UNLAWOUL, AND SHALL SUBJECT AN E LOY 0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA LARS ($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 relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Date,! - 3^� Signature (Applicant or Agent zn � mOT � oak . 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 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:— Policy Number: _ 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, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date [,- 3 S Applic WARNING: FAILURE TO SECU WORS' COMPENSATION COVERAGE IS UNLAWOUL, AND SHALL SUBJECT AN E LOY 0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA LARS ($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 relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Date,! - 3^� Signature (Applicant or Agent DESCRIPTION FINANCIAL INFORMATION ACCOUNT,* QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID.BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PV SYSTEM - ARRAY, FIRST 20 101-0000-42403 0 $24.17 $0.00 -PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PV SYSTEM - ARRAY, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT .# CHECK # CLTD BY Total Paid for ELECTRICAL: $48.34 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE' PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 Permit Details PERMIT NUMBER ,,. Cit ,. _ �.�:. • y of La Quin to BS0b2015, 0150 Description: 5.23kW PV SYSTEM - (16) 327W PANELS/(1) INVERTER ADDITIONAL Type: SOLAR Subtype: Status: APPROVED Applied: 8/25/2015 PJU Approved: 9/2/2015 LUR Parcel No: 774173004 Site Address: 53810 AVENIDA MENDOZA LA QUINTA,CA 92253 Subdivision: -SANTA CARMELITA VALE LA QUINTA Block: 249 Lot: 21 Issued: UNIT 23 Lot Sq Ft: 0 Building Sq Ft: 0. Zoning: Finaled: Valuation: $20,928.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 5.23kW SOLAR ARRAY - (16) 327W SUNPOWER E20 PANEL W/ (1) PVI-4.2-OUTD-S-US-A INVERTER [281SF] 2013 CALIFORNIA ELECTRICAL CODE. SUBMITTED THREE SETS Printed: Thursday, September 03, 2015 11:20:57 AM 1 of 2 ?`?SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE PHILIP JUAREZ 8/25/2015 8/25/2015 SUBMITTED THREE SETS LEFT A MESSAGE W/MONICA FOR ISMAEL LETTING HIM TELEPHONE CALL LUIS URIBE 9/2/2015 9/2/2015 KNOW THAT THE PERMIT WAS READY TO BE ISSUED. 'CONDITIONS CONTACTS NAME TYPE NAME ADDRES51 CITY STATE ZIP PHONE FAX EMAIL APPLICANT SMART ENERGY SOLAR INC 1641 COMMERCE CORONA CA 92880 (760)880-9225 STREET CONTRACTOR SMART ENERGY SOLAR INC 1641 COMMERCE CORONA CA 92880 (760)880-9225 STREET OWNER LETICIA LOZA 53810 AVENIDA LA QUINTA CA 92253 (760)880-9225 MENDOZA Printed: Thursday, September 03, 2015 11:20:57 AM 1 of 2 ?`?SYSTEMS INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES SOLAR FINAL" BLD FINANCIAL ' CBY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA:- SArPV PVSYSTEM - ARRAY, ' 101-0000-42403 0 $24.17 $0.00 FIRST 20 PV SYSTEM - ARRAY, 101-0000-42600 0 $24.17 $0.00 FIRST 20 PC Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 • 00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES SOLAR FINAL" BLD BOND INFORMATION Printed:Thursday, September 03, 2015 11:20:57 AM 2 of 2 SYSTEMS Iain # City of La Quinta X Building &T Safety Division i 78-495 Calle Tampico \, La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # V, Project Address: 52 6 iU Aveni 4 , Owner's Name: A. P. Number: Address: Legal Description: City,ST Zi Contractor: S �rter Tele h ne - o 0 P (� i S s� zr Address: 6¢ Project Description: 6--Z3Z ✓< W City, ST, Zip: 9Z ry ti.., Telephone: 4S I -+-)16 v State Lic. # : 9qr-00. City Lic. #.: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: le one: P Construction TYP e• ev OecuPan eY: State Lic. #• New Add'n t J type a cit cle one • Alter Repair Demo Name of Contact Person: ISrpt Ta/�G� Sq. Ft.:#Stories: # Units: Telephone # of Contact Person: 4 Sl -/o7-f3tfi Estimated Value of Project: 2� APPLICANT: DO NOT WRITE BELOW THIS LINE M Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted a. Item Amount Structural Calcs. Reviewed, ready for corrections Plan 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 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 3'! 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 Fees, Total Permit Fees CERTIFICATE OF COMPLIANCE Certificate Number 20150223-E246423 RECEIVED Report Reference E246423-20040917 Issue Date 2015 -FEBRUARY -23 AUG 2 5 2015 Issued to: SUNPOWER CORP CIN OF LA QUINTA COMMUNITY DEVELOPMENT 77 RIO ROBLES k SAN JOSE CA 95134 This is to certify that PHOTOVOLTAIC MODULES AND PANELS representative samples of (See addendum for additional information.) Have been investigated by UL in accordance with the Standard(s) indicated on this Certificate. Standard(s) for Safety: UL 1703, 3rd Edition, revised May 20, 2014, "Standard for Safety for Flat -Plate Photovoltaic Modules and Panels." Additional Information: See the UL Online Certifications Directory at www.ul.com/database for additional information Only those products bearing the UL Listing Mark for the US and Canada should be considered as being covered by UL's Listing and Follow -Up Service meeting the appropriate requirements for US and Canada. The UL Listing Mark for the US and Canada generally includes: the UL in a circle symbol with "C" and "US" identifiers: cogs the word "LISTED"; a control number (may be alphanumeric) assigned by UL; and the product category name (product identifier) as indicated in the appropriate UL Directory. Look for the UL Listing Mark on the product. 1� CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPRO� ED FOR CO LDA .IE� William R. Camey, Director, North American Certification Programs UL LLC L Any Infor ation and documentation involving UL Mark services are provided on behalf of UL LLC (UL) or any authorized licensee of UL. For questions, please contact a local UL Customer Service Representative at www.ul.comlcontactus Page 1 of 2 s03�0 v� �WQ Zots'ot� $lo air . .f.'. _ - C , .. - y,, °! .' - 1 F . t k 4 .. �� ° 6 L} .t' tti# t F C� f - �6 t { .� jR a y >a y r s ° 5 °� CERTIFICATE O{tF C'OM>PLIANCJE y, r ,✓>{ t t vfi r t 4 s> '� ; , ' 2a z a 4 ,� ' z �y h f 1 :. ° r 3. y' J. V I v w m c*J c S } $� e, S. s a> -* z h t £ °s :, . *>, Certificate Number ° fa2 - 64 K � a z a r y t 0150223"E24 23 } f,: :> rjyf S t 4 # '' ° k Viy it y- "�' fib- . G= ♦ 4 Report Reference E246423 20040917 t x J !, . ; '{ " Issue Date 2015 FEBRUARY 23 ' a Q' :; t� : " '"' •kF J a: } `�£ t .x a F n a ° .k �:4§ d `9a3: kt.. } � ° ,y :. ,� .. 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I I, r4 "` f .{ y 4,. a t n r3 E , Models XXX EYY #t #,where XXX; representsSPR or�SPV, YY represents 18, t19, 20 or 21 and is Fany number from 440 to 375 or 345 .' 285 or 250 to 225 and may be followed by CQM and%or BLK i v - - Yt� V ) ,. 1 } .* .s Y_� t•*F } r3>'. F z" `;E'"+, V fi x ,«:J , Y -t k *. �,"y C ) 3` - . v{y f n�}3 4 "3 2 q . f ¢ 1 "t '$ bidels XXX 450 to _435-,XXX-345k't -311, LXXX 262 to X233 followed by J,'NJ, NX or`X mayY be `t followed by BLKt or WHT; followed by ,D, I, or. U, where XXXX represents SPR or4SPV n \ h } t °.. } i, + tea !� N Mot \. a - 3 t Models XXX XYY ### where XXX represents SPR' or SPV YY represents 18; 19; 20or 21 antl ### is - ;any number from 486 to 435 or 365 to 3'10 or 274 to 233 and mays be followed by COM andlor BLK a ' :., a ." A r * ., {i r E { { k• V.Ji + ,,, y ,«c H k , z . - t, Flat Plate Photovoltaic=Modules with construction compliant to ModUle Fire y e a a f ,k ; ., t 4 3 ? 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Camey D1,:gt _r North American ccnmcat on Programs ii a ' cN ♦ P +fi i J , ..t`v11-- UL LLC � S.. p "a. ! giI, � . a 4 ^: '.}y F .♦ . k ti r :9' ,. s * x.F: ai' M '4v. :N. .3{ S P. is ».. ,K " Any info ion and cib' ntahon invoWmg UL Mark, se ices am provided(."haff of UL LLC.�UL) or any euthonzed lu:ense.—.UL For quesfioos please { :i cz i p icy,. - . contact a IocaYUL Cu3tomer Serve Repmsentatrve a<www ul coMcontactus ' t,+ vz 2 ♦• .r .,Y{ a .fh a :s :::r�.r s�-° � �. v k rr e. ...;.?N s �� v € �: *. t t 4v{?_. 1 'a _:�J{ {.{ At s f 3' '~,tk X <: a- f .. . i r, { o '� �. { n...{.. 'r .4 > t,.� .tri.. Page 2 of 2 a a Y t r J s. ' , - i ` 7 +. Certificate Certificate no. US 82140038 01 License Holder: Unirac Inc. 1411 Broadway NE Albuquerque NM 87102 USA Manufacturing Plant: Unirac Inc. 1411 Broadway NE Albuquerque NM 87102 USA Test report no.: USA- 31440029 001 Client Reference: John Nagyvary Tested to: Subject 2703 No. 2 (11-13=2012) I A 7UVRheinland Certified Product: Module Rack Mounting System License Fee -Units Model Designation: SolarMount (SM) 7 Maximum Size of PV Module: 65" long and 39.125" wide Maximum System Voltage of PV Module: 1000 VDC Maximum overcurrent protection rating of PV Module: 30 A Fire Rating: Class A when installed with Type 1 fire rated modules, Type 2 fire rated modules," Type .3 fire rated modules, Type 10 fire rated modules. (continued) Appendix: 1,1-4 7 Licensed Test mark: Date of Issue (day/mo/yr) 19/12/2014 7UVRheinla)US TOV Rheinland PTL, LLC, 2210 South Roosevelt Street, Tempe. Arizona 85282, Tel (480) 986-1700, Fax (775) 314-6458 B t Celt Certificate no, r ificate US 82140038 02 License Holder: Unirac Inc. 1411 Broadway NE Albuquerque NM 87102 USA Manufacturing Plant: Unirac Inc. 1411 Broadway NE Albuquerque NM 87102 USA Test report no.: USA- 31440029 001 Client Reference: John Nagyvary Tested to: Subject 2703 No. 2 (11-13-2012) TOVRheinland Certified Product: Module Rack Mounting System License Fee - Units (continued) 7 Modules Evaluated & Qualified for Mechanical Load.: Trina Solar TSM-255PA05.08 Design Load: Positive = 112 psf, Negative = 50 psf Centrosolar TP6 250 SW and E 250B Design Load: Positive = 112 psf, Negative = 50 psf TSMC Solar TS -150C2 Design Load; Positive = 35 psf, Negative = 35 psf e Modules from the same series with same frame are qualified if their area is less than or equal to test module area. (continued) 7 Appendix; 1,1-4 Licensed Test mark: Date of Issue (day/mo/yr) 19/12/2014 TOVRhelnla)US TOV Rheinland PTL, LLC, 2210 South Roosevelt Street, Tempe, Arizona 85282, Tel (480) 986-1700. Fax (775) 3146458 Certificate Certificate no. US 82140038 03 License Holder: Manufacturing Plant: Unirac Inc. Unirac Inc. 1411 Broadway NE 1411 Broadway .NE Albuquerque NM 87102 Albuquerque NM 87102 USA USA Test report no.: USA- 314 40029 001 Client Reference: John Nagyvary Tested to: Subject 2703 No. 2 (11=13-2012) TUVRheinland Certified Product: Module Rack Mounting System License Fee - Units (continued) 7 Modules Evaluated & Qualified for Electrical Bonding: AU Optronics (BenQ Solar) PM Series Canadian Solar CS5A=M, CS6P-M, C56P-P, CSX -P Centrosolar America C -Series, E -Series ET Solar ET AC Module, ET -Module Hanwha Solarone HSL 60 Hyundai Heavy Industries MG Series Kyocera KD -F Series LG Electronics Mono Neon, Mono X Phono Solar Technology All Standard Modules (continued) Appendix: 1,1-4 Licensed Test mark: Date of Issue (day/mo/yr) 19/12,/2014 TUVRheinland uS TOV Rheinland PTL, LLC, 2210 South Roosodelt Street, Tempe, Arizona 85282, Tel (480)966-1706. Fax (775) 314.6458 Certificate TUVRheinland Certificate no. Ve 82I40034- nY License Holder: Manufacturing Plant: Unirac Inc. Unirac Inc. 1411 Broadway NE 1411 Broadway NE Albuquerque NM 87102 Albuquerque NM 87102 USA USA Test report no.: 'USA- 31440029 001 Client Reference: John Nagyvary Tested to: Subject 2703 No. 2 (11-13-2012) Certified Product: Module Rack Mounting System LicenseFee- Units (continued) 7 Modules Qualified for Electrical Bonding [continued] Renesola All 60 -cell Modules Sharp ND240QCJ, ND240QCS, NDQ235F4 Suniva MV Series, OPTIMUS Series SunPower AC, E -Series, Sig Black, X -Series Suntech STP XXX Trina PD05, PA05 Yingli Panda -160, YGE 60 Yingli YGE-Z 60 Sun Edison / MEMC F -Series, R -Series SolarWorld SunModule Protect, SunModule Plus 7. Appendix: 1,1-4 Licensed Test mark: Date of Issue (day/mo/yr) 19/12/2014 TUVRheinland uS TOV Rheinland PTL, LLC, 2210 South Roosevelt Street, Tempe, Arizona 85282, Tel (480) 966-1700, Fax (775) 314-6458