13-1577 (SOL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number
13-00001577
Property Address:
79830 RANCHO LA QUINTA DR '
APN:-4-9=.560-003-
- -
Application description:
SOLAR
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
35360
T4tit 4 4 Q"
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
wwr'O" T**WF6d4--*
Owner:
PETITE, DONALD C
79830 RANCHO LA QUINTA DR
LA QUINTA, CA 92253
CSCac �s M'u4�,�N Contractor:
Applicant: Architect or Engineer- \ SOLARCITY CORPORATION
K.4d& wul b) 2896 METROPOLITAN PLACE
POMONA, CA 91767
��1°illol� (650)638-1028
LiC. 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 Professionals Code, and my License is in full force and effect.
License Class: B CIO C20 License No.: 888104
Date: 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).:
1 _ 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
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.). '
(_ 1 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.).
1 _ ) 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 Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 4/29/14
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 LIBERTY MUTUAL Policy Number WA766DO66265023
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: 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 Director of Building and Safety 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 Quima, 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 county to enter upon the above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number . . . . . 13 -000D1577 -
Permit . . . ELECTRICAL 2013
Additional desc .
Permit Fee . . . 47.66 Plan Check Fee
.00
Issue Date- 2/27/14 Valuation
0
Expiration Date 10/21/14
Qty Unit Charge Per
Extension
1:00 23.8300 LS ELEC DEVICES, FIRST 20
23.83
1.00 23.8300 EA ELEC SERVICES
23.83
-----------------------------------------------------------------------------
Special Notes and Comments.
16:2kW SOLAR ARRAY —(65) 250W TRINA
PANELS W/ (1) 11,400W FRONIUS INVERTER
[1,170SF) 20.10 CALIFORNIA ELECTRICAL
CODE.
February 26, 2014 3:26:30 PM AORTEGA
LOCATION TRANSFERRED FROM PERMIT.
ISSUANCE ADDRESS 78-930 RANCHO LA QUINTA
TO ACTUAL INSTALL AND PROPOSED ADDRESS
79-830 RANCHO LA QUINTA.
April 29,'2014 8:35:22 AM AORTEGA
------------------------- --------------------------------------------------
Other Fees BLDG -STDS ADMIN (SB1473)
2.00
PLAN CHECK, ELECTRICAL
35.75
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid Credited
Due
----- ---------- ---------- ----------
Permit Fee Total 47.66 47.66 .00
.00
Plan Check Total .00 ..00 .00
.00
Other Fee Total 128.32 128.32 .00
.00
Grand Total 175.98 175.98 .00
.00
LQPE&M IT
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,ityl 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
13-00001577
Property Address:
78930 RANCHO LA QUINTA DR
APN:
646-370-007- - -
Application description:
SOLAR
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
35360
Applicant: Architect or Engineer:
or —
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Sactlon 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
LlrenseClaes: H C10 C20 LE eNo.: 888104
Date: Contractor: �1
OWNLR-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 sale 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 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 Name: _
Lender's Address:
LQPERMIT
Owner:
PETITE, DONALD C
79830 RANCHO LA QUINTA DR
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/26/14
Contractor: _—
SOLARCITY CORPORATION
2896 METROPOLITAN PL CE
POMONA, CA 91767
(650)638-1028
C.
P.
Lic. No.: 888104
,. WORKER'S COMPENSATION DECLARATION V —
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 LIBERTY MUTUAL Policy Number WA766DO66265023
_ 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 y wlth�provlslons
r"
Date: Applicant:
WARM :FAILURE TO SECUR 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 Director of Building and Safety 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 Qulnta, 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 car . I agree to comply with all
city and county ordinances and state laws relating to building construction, and h authorize representatives
of bK ty er upon the aWvo,mantionod property for Insp tlan pure
]ate: 7 entSignature (Applicant or Agenty:
Application Number . . . . . 13-00001577
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee 47.66 Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date 8/25/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC DEVICES, FIRST 20
23.83
1.00 23.8300 EA ELEC SERVICES
23.83
-
---- Special Notes ^and -Comments
16.2kW SOLAR ARRAY - (65) 250W TRINA
PANELS W/ (1) 11,400W FRONIUS INVERTER
[1,170SF] 2010 CALIFORNIA ELECTRICAL
CODE.
February 26, 2014 3:26:30 PM AORTEGA
Other Fees . . . . . . . . . BLDGrSTDS ADMIN (SB1473)
2.00
PLAN CHECK, ELECTRICAL
35.75
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid Credited
^^ ~^'^�
Due
Permit Fee Total 47.66 .00 .00
47.66
Plan Check Total .00 .00 .00
.00
Other Fee Total 128.32 .00 .00
128.32
Grand Total 175.98 .00 .00
175.98
LQPERMIT
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