BSOL2015-0065LICENSED 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.
Licen a Cl ss: 46 B C10 A Lice se : 88 04 r
1
Date: Contracto oil
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt fr 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 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
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'
comp n tion, as provided for by Section 3700 of the Labor Code, for the performance
221 w for which this permit is issued.
Ihave and will maintain workers' compensation insurance, as required by
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 houId ome subject to the
workers' co pe sation provisions of Section 370 of he L o Code, I shall forthwith
comply�wiDt tho rovisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONC VERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE D 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 relating to building
construction, and hereby authorize representatives o o enter on the above
mentione pro ertyfor' spection purposes.
Date: Signature (Applicant or Age t):
Twit 4 4 Qu!Kro
VOICE (760) 777-7125
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
fAX (760) 777-7011COMMUNITY
DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: . 6/1/2015
Application Number: BSOL2015-0065
Owner:
Property Address: 49465 BRIAN CT
QUINTON DALL
APN: 602290046
49465 BRIAN CT
_
'
Application Description: QUINTON / 68 ROOF MOUNTED PANELS AND (3) INVERTERS 17.68 KW
LA QUINTA, CA 92253
a
Property Zoning:
C-) C
Application Valuation: $39,072.00
Applicant:
Contractor:
0,
a �
SOLARCITY CORPORATION
SOLARCITY CORPORATION
v
3055 CLEARVIEW WAY
3055 CLEARVIEW WAY
_o
D L-%9
ATTN ZOE STEELE
ATTN ZOE STEELE
SAN MATEO, CA 94402
SAN MATEO, CA 94402
- L:
(650)963-5630
Llc. No.: 888104
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.
Licen a Cl ss: 46 B C10 A Lice se : 88 04 r
1
Date: Contracto oil
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt fr 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 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
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'
comp n tion, as provided for by Section 3700 of the Labor Code, for the performance
221 w for which this permit is issued.
Ihave and will maintain workers' compensation insurance, as required by
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 houId ome subject to the
workers' co pe sation provisions of Section 370 of he L o Code, I shall forthwith
comply�wiDt tho rovisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONC VERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE D 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 relating to building
construction, and hereby authorize representatives o o enter on the above
mentione pro ertyfor' spection purposes.
Date: Signature (Applicant or Age t):
FINANCIAL .• 1
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$2600 $0.00
PAID BY METHOD
RECEIPT # CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00 $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
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PV SYSTEM - MISC EQUIPMENT
101-0000-42403
0
$48.34
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PV SYSTEM - MISC EQUIPMENT PC
101-0000-42600
0
$48.34
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $145.02 $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
Description: QUINTON / 68 ROOF MOUNTED PANELS AND (3) INVERTERS 17.68 KW
Type: SOLAR Subtype: Status: APPROVED
Applied: 5/29/2015 SKH
Approved: 6/1/2015 JFU
Parcel No: 602290046 Site Address: 49465 BRIAN CT LA QUINTA,CA 92253
Subdivision: TR 29053-1 Block: Lot: 23
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $39,072.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
COMPLETION DATE
Details: 17.68 kW SOLAR ARRAY - (68) 260W KYOCERA KU2606XPA PANELS W/ (2) ABB PVI-4.2-OUTD-S-US-Z-A INVERTERS & (1) ABB PVI-3.6-
OUTD-S-US-Z-A INVERTER + MAIN SERVICE PANEL UPGRADE TO 225A + 125A SUBPANEL [1,224 SF] 2013 CALIFORNIA ELECTRICAL
CODE.
Printed: Monday, June 01, 2015 2:06:00 PM 1 of 3
CRSYSTEMS
CHRONOLOGY
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
E-MAIL
JAKE FUSON
6/1/2015
6/1/2015
NOTIFIED MELANIE W/ SOLAR CITY THAT PLANS WERE
APPROVED AND PERMIT WAS READY TO ISSUE.
PLAN CHECK SUBMITTAL
RECEIVED
STEPHANIE KHATAMI
5/29/2015
5/29/2015
CONDITIONS
CONTACTS
NAME TYPE NAME
ADDRESSI
CITY STATE
ZIP
PHONE FAX EMAIL
APPLICANT SOLARCITY CORPORATION
3055 CLEARVIEW WAY
SAN MATEO CA
94402
CONTRACTOR SOLARCITY CORPORATION
3055 CLEARVIEW WAY
SAN MATEO CA
94402
OWNER QUINTON DALL
49465 BRIAN CT
LA QUINTA CA
92253
Printed: Monday, June 01, 2015 2:06:00 PM 1 of 3
CRSYSTEMS
Printed: Monday, June 01, 2015 2:06:00 PM 2 of 3 OrWySTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
SOLAR FINAL" BLD
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$2.00
1 $0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $2.00 $0.00
BSA:
PV SYSTEM - 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
PV SYSTEM -MISC
101-0000-42403
0
$48.34
$0.00
EQUIPMENT
PV SYSTEM - MISC
101-0000-42600
0
$48.34
$0.00
EQUIPMENT PC
Total Paid for ELECTRICAL: $145.02 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERM1T ISSUANCE: $91.85 $0.00
TOTALS:••
Printed: Monday, June 01, 2015 2:06:00 PM 2 of 3 OrWySTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
SOLAR FINAL" BLD
Printed: Monday, June 01, 2015 2:06:00 PM 2 of 3 OrWySTEMS
Printed: Monday, June 01, 2015 2:06:00 PM 3 of 3
-CYC7 SYSTEMS
Bln.#
Of %ci QUfitta
Btdkgng 8r Safely Division
P.O. Box 1504,-78-495 Calle Tampico
La.QLdnta, CA 92253 - (760) 777-7012
Building Pennit Application'and Tracking Sheet
Permit #
s3t)Laa5 -W_
ProjectAddress:
Owner's Name:. I
A P. Number.
Address: (f rj7
Legal Description:
I?)
City, ST, zip: La, Quinta, CA
Contractor Solar City -
Telephone:
Address: 3055 Clearview Way.
Pmje4Descrip6oiiq roof mounted solar panels .
city, sT, zip: San Mateo, CA, 9440.2 .
-_invert e d;
Telephone: 650-638-1028
`
State Lia # : 888104 City Lic. C.`IV
Arch-, Engr., Designer-
esignerAddress:
Address:
City, ST, Zip:
Telephone:
Construction Type: , occupancy:
State Lia #:
Project type (circle one): New Add'n Alter Repair Demo
Name of contactPerson Elena Loya
Sq. Ft:
# Stories:
# Units:
Telephone # of Contact Person: (442)256-1134
Estimated value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Wd
Reeld
TRACMG
PERMPPFEES
Plan Sets
Plan Check submitted
Item Amount
StrgcturalCaics.
Reviewed, ready for ISSUE
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Cheek Balance -
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Meeharileai
Grading plan
Z'! Review, ready for correctionsfissue
Electrical
Subcoetaetor List
Called Contact Person
Plumbing
Grant Deed
Plans pteked up
&bLL
H.O.A. Approval
Plans resnbmtlted
Grading
IN ROUSE:-
Review; ready for eorreetlonsfissae
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Tib. Appr
Date of permit issue
School Fees
Total Permit Fees
m!FM Now
MAY 2 9 2015.
0ItY OF LA-QUINTA
COMMUNITY DEVELOPMENT