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BSOL2014-0031Applicant: MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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: _ License No.::LIC-0108665 Da ?W -0L, I� 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).: (_) 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 ) 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 Contractor: MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (951)736-7000 Llc. No.: :LIC -0108665 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: _ 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 agre that, if I should become subject to the workers' compensation provisions of Secti n 700 of the Labor Code, I shall forthwith comply with those provisions.r Date: Wm V Z— Appl�t: 'WARNING: FAILURE TO SECURE ORKERV 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 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 stat laws relating to building construction, and hereby authorize representatives of this city ei Pon the above• mentioned property for inspection purposes. II Dater V 12 Signature (Applicant or Agent) VOICE (760) 777-7125 78-495 CALLE TAMPICO D LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/12/2014 Application Number: BSOL2014-0031 Owner: Property Address: 51297 AVENIDA DIAZ FRED DEBOOM APN: 773043034 P 0 BOX 533 Application Description: 6.45kW PV SYSTEM - (30) 275W PA FMASMICROJINV/125A LA QUINTA, CA 92253 Property Zoning: Application Valuation: $35,000.00 Applicant: MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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: _ License No.::LIC-0108665 Da ?W -0L, I� 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).: (_) 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 ) 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 Contractor: MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (951)736-7000 Llc. No.: :LIC -0108665 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: _ 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 agre that, if I should become subject to the workers' compensation provisions of Secti n 700 of the Labor Code, I shall forthwith comply with those provisions.r Date: Wm V Z— Appl�t: 'WARNING: FAILURE TO SECURE ORKERV 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 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 stat laws relating to building construction, and hereby authorize representatives of this city ei Pon the above• mentioned property for inspection purposes. II Dater V 12 Signature (Applicant or Agent) FINANCIAL • !• DESCRIPTION ACCOUNT QTY` AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $2.00 $2.00 • 11/12/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $2•.00 $2.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PV SYSTEM - ARRAY, FIRST 20 101-0000-42403 0 $24.17 $24.17 11/12/14 PAID BY . METHOD RECEIPT # CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA DESCRIPTION ACCOUNT ' QTY AMOUNT PAID PAID DATE PV SYSTEM - ARRAY, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 11/12/14 PAID BY METHOD RECEIPT. # CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PV SYSTEM - MISC EQUIPMENT 101-0000-42403 0 $24.17 $24.17 11/12/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PV SYSTEM - MISC EQUIPMENT PC 101-0000-42600 0 $24.17 $24.17 11/12/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA Total Paid for ELECTRICAL: $96.68 $96.68 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 11/12/14 PAID BY METHOD RECEIPT # s CHECK # CLTD BY MOHR POWER SOLAR, INC. CHECK R2811 3067 MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 •TALS: $190.53 $190.53 Description: 6.45kW PV SYSTEM - (30) 275W PANELS+M215 MICROINV/125A SUB Type: SOLAR Subtype: Status: APPROVED Applied: 10/23/2014 MFA Approved: 11/6/2014 JFU Parcel No: 773043034 Site Address: 51297 AVENIDA DIAZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 49 Lot: 6 Issued: UNIT 4 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $35,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NOTES Details: 6.45kW SOLAR ARRAY - (30) 275W SUNMODULE PANELS+M215 ENPHASE MICROINVERTERS AND 125A SUBPANEL [540SF) 2013 CALIFORNIA ELECTRICAL CODE. Printed: Wednesday, November 12, 2014 3:20:52 PM 1 of 3 spa" SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK CALLED MAURY FROM MOHR SOLAR TO NOTIFY PLANS WERE COMPLETE/READY FOR PICK JAKE FUSON 11/6/2014 11/6/2014 APPROVED AND READY FOR PICK-UP. UP CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 CONTRACTOR MOHR POWER SOLAR, INC. 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 OWNER FRED DEBOOM P O BOX 533 LA QUINTA CA 92253 Printed: Wednesday, November 12, 2014 3:20:52 PM 1 of 3 spa" SYSTEMS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE 'RECEIPT # CHECK # METHOD PAID BY CLTD BY BY BSAS SB1473 FEE 101-0000-20306 0 $2.00 $2.00 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA INC. Total Paid forBUILDING STANDARDS ADMINISTRATION $2.00 $2.00 BSA: PV SYSTEM - ARRAY, 101-0000-42403 0 $24.17 $24.17 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA FIRST 20 INC. PV SYSTEM - ARRAY, 101-0000-42600 0 $24.17 $24.17 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA FIRST 20 PC INC. PV SYSTEM - MISC 101-0000-42403 0 $24.17 $24.17 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA EQUIPMENT INC. PV SYSTEM - MISC 101-0000-42600 0 $24.17 $24.17 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA EQUIPMENT PC INC. Total Paid for ELECTRICAL: $96.68 $96.68 PERMIT ISSUANCE 101-0000-424040 $91.85 $91.85 11/12/14 R2811 3067 CHECK MOHR POWER SOLAR, MFA INC. Total Paid forPERMIT ISSUANCE: $91.85 $91.85 TOTALS:•0 •• .53 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES SOLAR FINAL*" Printed: Wednesday, November 12, 2014 3:20:52 PM 2 of 3 ewSYS 7Fti1S Bin # OO� I City of La Q uin to Building 8t• Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # II '' Project Address: 51aq vE&j - Owner's Name: A. P. Number: 7 7 30 Ll3 p3 Address: 9V OW 1 Legal Description: City, ST, Zip: 1"4 C Contractor: O� f 7/� L Telephone: <?z Address: Project Description: City, ST, Zip: vtJ C �� v S S TEiY`) Tele h0 nc :9 51 v State Lic. # : 3 City Lie. #. Arch., Engr., Designer: s Address: City., ST, Zip: Telephone: ; Construction Type: Occupancy: State Lie. #• New Add'n AlterRe a one) Repair Demo Project b5P (circle Name of Contact Person: 1,j 6)L Z Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Value of Project: aAK 0.0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted 2 1 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calrs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" 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 HOUSE:- 3" Reviciv, ready for corrections(ssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees