BSOL2016-0078?I✓t, auuw
78-495 CALLS TAMPICO ."
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760)777-7011
INSPECTIONS (760) 777-7153
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.
Licensee C
lass: C39 B C46 C36 C20 C10 C43 <ic se No.: 468117
Date: `� ` /i ' C► Contra or:
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 703.1.5 by any applicant fora
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 Na
Lender's Add
WORKER'S COMPENSATDN DECLARATION
I hereby affirm under penalty of perjury one oftlie following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700of the Labor Code, for the performance
of the work -for which this permit is issued.
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 es to become* subject to the workers'
compensation laws of California, and agree that, if I shoulvvflcme.subject to the
workers' compensation provisions of Section 3:00 of t ab9r Code, I shall forthwith
comply with those provisions.
Date: y'�.3- 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 cancelltion.
I certify that I have read this applicatiori and sta-e that thea bove
in
n is correct.
I agree to comply with all city and county ordinances and state laws r ti g to building
construction, and hereby authorize representatives of this ci er on the
above-mentioned property for inspection purpcses.
Date: _4t�fS'/lCi Signature (Applicant crAgentT
ate:
Application Number:
BSOL2016-0078
Owner:
Property Address:
53705 AVENIDA NAVARRO
GOODS JOHN SJF TRUST
T
I
APN:
774134020
A . ' �-�
53705 AVE NIDA r,AVARRO • =
Q
Application Description:
GOODE / 7.8kW PV SYSTEM - (28) 280W PANELS/(2) INVERTERS
LA QUINTA, CA 92253
Property. Zoning:
t�
"a
Application Valuation:
$28,000.00
��
Q
Applicant`.
Contractor: �9 y
cV
PETERSEN-DEAN INC DBA PETERSENDEAN
PETERSEN-DEAN iNC DBA PETERSfN
EAN
39300 CIVIC CENTER DRIVE
39300 CIVIC CENTER%D
rr ✓d
t
a
FREMONT; CA 94538
FRENIONT, CA 94 38
-C
(510)371-6500 .
Llc. No.: 468117
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.
Licensee C
lass: C39 B C46 C36 C20 C10 C43 <ic se No.: 468117
Date: `� ` /i ' C► Contra or:
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 703.1.5 by any applicant fora
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 Na
Lender's Add
WORKER'S COMPENSATDN DECLARATION
I hereby affirm under penalty of perjury one oftlie following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700of the Labor Code, for the performance
of the work -for which this permit is issued.
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 es to become* subject to the workers'
compensation laws of California, and agree that, if I shoulvvflcme.subject to the
workers' compensation provisions of Section 3:00 of t ab9r Code, I shall forthwith
comply with those provisions.
Date: y'�.3- 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 cancelltion.
I certify that I have read this applicatiori and sta-e that thea bove
in
n is correct.
I agree to comply with all city and county ordinances and state laws r ti g to building
construction, and hereby authorize representatives of this ci er on the
above-mentioned property for inspection purpcses.
Date: _4t�fS'/lCi Signature (Applicant crAgentT
FINANCIAL INFORMATION
i DESCRIPTION �`.`i�A000UNT QTY> AMOUNTs <� PAID :.+,PAID DATE'
k .k. t --z� ? k f E
BSAS SB1473 FEE
101-0000-20306 0 $2.00
$0.00
G 'PAID
ss+4^I BY
RECEIPT7 # r &r �
..�,r�'.< kr.. 2u, �i� r.
#'. CHECK # f CLTD BY
t."4 sxY.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00.
.� r.DESCRIPTION�>
T= ACCOUNT
a
'QTY
4�
AMOUNT �
; PAID '
PAID DATEF
PV SYSTEM - ARRAY, FIRST 20
101-0000-42403
0
$24.17.
$0.00
&,`
PAID:BY
METHOD
" " ,:
& r° RECEIPT#q
-' CHECK# }CLTDBY
".DESCRIPTION 'X� ",�
r ACCOUNT4
QTY
g ;AMOUNT�'°PAID~
K
PAID:DATE,
PV SYSTEM - ARRAY, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
3, _-,.., tix. 9
spMETHOD
RECEIPT# _ syr
y 3q CHECK#p
CLTDBY
q" „ T E DESCR.IPTIONY'�h" Fg
i- ACCOUNTg ire }
=QTYrk
AMOUNT
A �� PAIDs
PAID DATE
PV SYSTEM - MISC EQUIPMENT
101-0000-42403
0
$24.17•
$0.00
PAID,BY r �'," `. `
,Aa
`` ° -" METHOD f` g ':
a��.�'
'- RECEIPT # -
i
CHECK #� .
'CLTD BY-�
DESCRIPTION;,As"
ACCOUNT " 'QTY
r.e�'AMOUNT
ti w ;w PAID',,PAID:.yD
ATE '.
PV SYSTEM =.MISC EQUIPMENT PC
101-0000-42600
0
$24.17
$0.00
PAID BYn
METHOD .u�`
A ��. v RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $96.68 $0.00
DESCRIPTION`iQTY
P
AMOUNT ?
PAID e.
yi
10AD DATE;.
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
� 3 ,� PAID BY.:st
1; *.'METHOD` ` g
RECEIPT # `
,CHECK #wj
CLTD BYE`.
Total Paid for PERMIT ISSUANCE: $91.85 $0.00'.
TOTALS:•• • 0•
e
C6�fOE't1;F'�
Description: GOODE / 7.8kW PV SYSTEM - (28) 28OW PANELS/(2) INVERTERS
Type: SOLAR Subtype: Status: APPROVED
Applied: 4/4/2016 RSE
Approved: 4/13/2016 AOR
Parcel No: 774134020 Site Address: 53705 AVENIDA NAVARRO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 241 Lot: 10
Issued:
UNIT 23
Lot Scl Ft: 0 Building Scl Ft: 0- Zoning:
Finaled:
Valuation: $28,000.00 Occupancy Type: Construction Type:.
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: 7.8kW SOLAR ARRAY - (28) 280W SOLARWORLD PANEL/(1) FRONIUS PRIMO 5.0-1 AND (1) 3.8-1 INVERTER W/ (1) 100 AMP
SUBPANEL [504SF] 2013 CALIFORNIA ELECTRICAL;CODE. .
TPRI 73 04
Printed: Wednesday, April 13, 2016 2:37:02 -PM ': 1 of 3
5
CEWSYSTEMS
CHRONOLOGY
^a`: ;. ^ .. '.^ .�.a ...•ri.' ...n':',.: - s. .'..!E
SSTAEF NAME =;;ACTION DATE ' COMPLETION GATE j r NOTES
;CHRONO,LOGS(;TYPE
_ ^ ,a
,'
r..: ,, _
INFORMED APPLICANT OF COMMENTS, HE SAID IT IS FINE TO
MAKE WHATEVER NOTES ON THE PLANS THAT ARE
TELEPHONE CALL
AJ ORTEGA
4/12/2016
4/12/2016
NECESSARY FOR ISSUANCE, I WILL COMPLETE THE NOTES
AND LET HIM REVIEW AND APPROVE THE COMMENTS.
PHONED APPLICANT THAT PLANS ARE APPROVED WITH
TELEPHONE CALL
AJ ORTEGA
4/13/2016
4/13/2016
COMMENTS AND READY TO ISSUE
CONTACTS
^}:?tiF .^A sA-': .. u -a .,-": '5-�' �� � 3 !''..;
NAMETYPE_NAME,-
<} '.enl?a` •.��i.�.:^ :.ec _. "e �, _.83' '_
DDRE551', a CITY STATEr
`.. :.-z.�. �.a.aS' _ .E
ZIP ;PHONE FAX a EMAIL `?
::.. _ _
. Mx
-�a
APPLICANT
PETERSEN-DEANINC DBA
.39300 CIVIC CENTER
FREMONT
CA
94538
PETERSENDEAN
DRIVE
CONTRACTOR
PETERSEN-DEAN INC DBA'.
39300 CIVIC CENTER
FREMONT- .
CA
94538
PETERSENDEAN, •
DRIVE
Printed: Wednesday, April 13, 2016 2:37:02 -PM ': 1 of 3
5
CEWSYSTEMS
INSPECTIONS
PARENT PROJECTS
Printed: Wednesday, April 13, 2016 2:37:02 PM 2 of 3
SYSTEMS
FINANCIAL
INFORMATION
DESCRIPTION , -ACCOUNT QTY AMOUNT
:'
PAID
PAID DATE RECEIPT.# CHECK # . METHODpq�p gy CLTD.
_. ;
BSAS SB1473 FEE 101-0000-20306 0 $2.00
$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
$24.17
$0.00
EQUIPMENT
PV SYSTEM -MISC
101-0000-42600
0
$24.17
$0.00,
EQUIPMENT PC
Total Paid for ELECTRICAL: $96.68 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00 .
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
• •0 00
INSPECTIONS
PARENT PROJECTS
Printed: Wednesday, April 13, 2016 2:37:02 PM 2 of 3
SYSTEMS
1ST BLDG NS (1 WK)
AJ ORTEGA.
4/4/2016
4/11/2016--1
4/12%2016 APPROVED -
CONDITIONS
TEMPERATURE DERATING FACTORS INCORRECT
FOR LOCAL AREA, MINIMUM (.50) DERATING AT
ROOF TOP CONDUCTORS IN CONDUIT AND (.82)
AMBIENT TEMPERATURE DERATING REQUIRED.
ADDITIONALLY, THE COMBINED (IF BEING
PROPOSED, NEED TO CONFIRM WITH DESIGNER)
GROUNDING ELECTRODE AND EQUIPMENT
CONDUCTOR NOT CONTINUOUS FROM
INVERTERS TO EXISTING GROUNDING.
ELECTRODE.
SPOKE WITH APPLICANT, APPROVED REDLINING
PLAN WITH REVIEWER COMMENTS - SIZED
COMBINED INVERTER OUTPUTS TO #6
CONDUCTOR AND SIZED COMBINED DC GEC/AC
EGC PER THE LARGER OF 250.122/250.166, AND
INCLUDED "UNSPLICED OR IRREVERSIBLY
SPLICED" NOTE ON PLAN. STATUS CHANGED TO
APPROVED WITH CONDITIONS
Bin #
Qty of La Quinta
Building 8z- Safety Division
78-495 Calle .'Tampico
La Quinta, CA 92253 - (760) 777-7012
00-7� Building Permit Application,and Tracking Sheet
Permit #
�b►i20 I to
Project Address: S37aS AtreN�t Nvaotmo
Owner's Name: �ab�c1c tit
A. P. Number:
Address: S 3 70 •f A y N N IBJ o R as
Legal Description:
City, ST, Zip;
ate, � �w zaS3
Contractor: ♦ R S a1D ".)
• TP ele hone• Z -2 L
L2- o
Address: kDZp
Project Description: f"GS tlbR KOVV� ��
City, ST, Zip: I ✓eesThe l� 14 �l �SrD9
S' .stet t -A - 7. 8eW eS -mO Du%es.
Telephone --760 1
% 0
0 Z '4
............
Z L
I G1�TC!/S i!'O t71ap
v i
State Lic. # : L 811-7
City Lie. #.:
vnTtR.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
e one:
Cons n TY Pe: Occupancy:
:
aLi
c. te Lac. #:
Project type (circle ne • New Add'n After Repair Dem 0
Name of Contact Person: 4VIabot �
Sq. Ft.:#
Stories:
# Units:
Telephone # of Contact Person: ? (� p • q O
Estimated Value of Project:..
APPLICANT: DO NOT WRITE BELOW THIS LINE
H Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, readyfor corrections
Plan CheckDeposBt
Truss Calcs.
Called Contact Person
Plan Check Balan -e
Title 24 Calcs.
Plans picked upConstruction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for%corrections/ ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact pee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees