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BSOL2014-00041� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application: Number: Property Address: APN: Application Description: Property Zoning: Application, Valuation: c&y/ 4 4 4" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BSOL2014-0004 45280 DEBBIE DR 604372004 4.3kW PV SYSTEM - (17) 255W PANELS/(1) INVERTER $9,500.00 Applicant: SOLARCITY CORPORATION 3055 CLEARVIEW WAY ATTN ZOE STEELE SAN MATEO, CA 94402 uaNSED CONTRACTOR'S DECLARATION I hereby affirm underpenalty of perjury that I,am;licensed under provisions of Chapter 9 (commencing with Section 7000)of bivision 3 of the Business•and Professions Code, and my License is in full force and effect. License Class: Gcens Date: Contractor: OWNER-BUILEVER DECLARATION I hereby affirm under penalty of perjury that 1 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, orrepair 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 aIle d exemption. Any violation of Section 70315by any applicant for a permit subjects the applicant to,a.civil penalty of not more than five'hundred dollars ($500).: (� 1, as owner of the, property, or, my employees with wagesas their sole compensation,, will do the work, and the structure isnot 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/14/2014 Owner: POLK, GERALD 'PO BOX.3005 LAKE ARROWHEAD, CA 92352 Contractor: SOLARCITY CORPORATION 3055 CLEARVIEW WAY ATTN ZOE STEELE SAN MATEO, CA 94402 (650)963-5100 Llc. No.: 888104 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 LaborCode, 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 policynumber are: Carrier:_ Policy Number: _ 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 agreethat, if i should become subject the workers' compensation provisions of Section 3100 of the I'ah& Code, sh forthwith comply with• pose piuvisions. Date: NAVY / ADolicant: WARNING: FAILURE TO SECURE WORKE1[7COiGIPENSATION 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. mmsen or nersentnrougn,ms or ner own employees, provioeo tnat the improvements are not intended or offered for sale. If, however; the building or improvement is sold APPLICANT ACKNOWLEDGEMENT within one year of completion, the owner -builder will have the burden of proving that he IMPORTANT: Application is hereby made to the Building Official for a,permit subject to or she did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application. (_) I, as owner of the property, am exclusively contracting with licensed contractors to 1. Each personupon whose behalf this application is made, each person at whose construct the project. (Sec. 7044,.Business and Professions Code: The Contractors' State request and for whose benefit work is performed under or pursuant.to any permit issued License Law does not apply to an owner of property who builds or improves thereon, and as a result of this application, the owner, and the applicant, each agrees to, and shall who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and State LicenseLaw.). employees for any act oromission related to the work being performed under or (_) I am,exempt under Sec. . B.&P:C. for this reason 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 daysfrom date of issuance of such -permit, or cessation of work Date: Owner: for 180 days will,subject permit to cancellation: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a constructionlending agency for the performance ofthe work for which this permit is.issued (Sec. 3097, Civ: C.).. Lender's Name: Lender's Address: I certify that l 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 We above- mention1proglirty,forinspection purposes. Date: U Signature (Applicant or Agent): FINANCIAL INFORMATION DESCRIPTION _ ACCOUNT'- ° QTYAMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID. BY METHOD RECEIPT.#.. CHECK # CLTD: BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA; $1.00 $0.00 DESCRIPTION ACCOUNT ` Q TY' " . AMOUNT PAID' ' PAID DATE` PV SYSTEM - ARRAY, FIRST 20 101=0000-42403 0 $23.83 $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 $23.83 $0.00 PAID BY METHOD RECEIPT`# CHECK # CLTD BY Total Paid forELECTRICAL: $47.66 $0.00 DESCRIPTION ACCOUNT; QTY AMOUNT PAID" PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $90.57 $0.00 PAID BY METHOD RECEIPT # CHECK4 CLTD BY Total Paid for PERMIT ISSUANCE: $90.57 $0.00 TOTALS:00 n 4 i City of La Qurnta Bldtt at Suety MUM P.Q. Bax ISO4, 78-495 Cab Tanpko $j�p�•Zp1�%• i�00 1a•gl� 4 CA 92233'.:(760) 777-7012 Bulbi Permit AppliC dm and'Tracft Sheet 9S 2 0 b ire r.. OwmesNeow. r f A. P. Numbs: Addrew. L19 CJ:Q {� b ice• > aqr• ST, Zip: �� } p� Gbyytr8ceor: 01 Adder a�- ► w : P rd� ak,n4: a f, M tLto OZ 1cSal a sista iii. � : l �, ir, -� �s•Z: p. AWIL, EW, C*OT. zip: iTd4'ice a�p�Y' -State Iaa #: Pmjed type (*do aye): New Add'n Abw Repair Demo Name of Cayte�t Psetaoyy: `' S v / Sq: Pt: d # Uft Tdtphone iE of Contact Persaw .. � Batlma ed Vabn of APPLICANT: DO NOT WRITE BELOW THIS UNE I 8o6mit d RWd Reed• .TBACA'lriG PBR�'f1?SFS' Pha Sib P1aw akuk oabmitta ball Among Sfrgdaeal Calea: .I Rnkwed, rad, tbreorrallom Plan CbeeiDepodt. . . �. Trays Cafes: Calkd Cowtact Pkraoa planC!►eeti Balanee- We 24 Cala. Mew Odced up Comtraetta6 ' Fbed ptatn plan Ph=rneb rifted, . UnhaWW Giaddyp p1m Y! Renew, rads rbc eorreeAoadmne 1Rabital . SebeootaeODrIbt .• CapedOonMatteetoa plgmblag ' Grant Deed Plata pkw up HrO.A. Approval Plea raalamftd Grading 194 HODU$. ''' Rwew, rads or perdoplr.Iatpaet Fse ' PbtndogAppronl' (�l[edCo�tatPerwm �. Aip.P. _ . Pab. Wb. Appy Date e[penelthas &Loot Fes ' TOW PerayltFM . •� �'�� 7,06 � �� A- �.. _ - .. - .