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BSOL2015-0094LICENSED 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 Cl ss: C46 B C10 A LicensNo.: 88404 Date, Contractor: OWNER -BUILDER DECLARATIO 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 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 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' compensation, as provided for by Section 3700 of the Labor Code, for the performance of k for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Se io 0 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 I should become subject to the workers' compensation provisions of Section f he La r ode, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 4VERAGE 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 in fation is correct. I agree to comply with all city and county ordinances and a e laws el ting to building construction, and hereby authorize representatives f hi city, to enler upon the above- mentione ro erty , r*spe�ion purposes. Date: ignature (Applicant or Age t)4VA MA -: � Q" VOICE (760) 777-7125 78-495 CALLE TAMPICO U FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/22/2015 Application Number: BSOL2015-0094 Owner: Property Address: 51725 AVENIDA DIAZ PATRICK CHYLIK APN: 773114012 51725 AVENIDA DIAZ a Application Description: CHYLIK RESIDENCE SOLAR INSTALL LA QUINTA, CA 92253 s 4 t= Property Zoning: 3 T Application Valuation: $21,083.40 ;'� M r a Applicant: Contractor: SOLARCITY CORPORATION SOLARCITY CORPORATION 4,., t0 I t 3055 CLEARVIEW WAY 3055 CLEARVIEW WAY , yi ATTN ZOE STEELE ATTN ZOE STEELE SAN MATEO, CA 94402 SAN MATEO, CA 94402 ���- -• _ (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. License Cl ss: C46 B C10 A LicensNo.: 88404 Date, Contractor: OWNER -BUILDER DECLARATIO 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 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 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' compensation, as provided for by Section 3700 of the Labor Code, for the performance of k for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Se io 0 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 I should become subject to the workers' compensation provisions of Section f he La r ode, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 4VERAGE 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 in fation is correct. I agree to comply with all city and county ordinances and a e laws el ting to building construction, and hereby authorize representatives f hi city, to enler upon the above- mentione ro erty , r*spe�ion purposes. Date: ignature (Applicant or Age t)4VA MA -: '— _;: p� : � °a `' ... ;� `� 7„k i4�f gr '�svxr'. rz ge."c r X", ? .t .. ;&: i <-c n - zyi aYr..> .. w, . 4 :'s' `x ' I'll: ti �tCTcY AMOUNTS PAID;E ;PAIDYDATE,. ,DESCRIPTIONxr �r<.. Y�`�vACCOUNT ,`.. BSAS SB1473 FEE 10170000-20306 0 $1.00 $0.00: .> F,Y l �•' ,,..1.. S 3 ? -'.i Tkv ,".Ys+.4'b .R �S,Y 'b BY s a t W i RECEIPT # �.� CHECK # CLTU BY �hXMETHOD' rC y a.7. a �g�i .�ifAl9'Lf'%M1F �f tZ.e..i3:'.Se'�"-rLrrc .. si,{g ry3v�.cw.✓[se i} SJ.,Ik n i iK�z e,Rl ..La ...Yi .c. ..t s;�, .Csu • '. Total Paid foeBUIL'DING STANDARDS ADMINISTRATION BSA: ',$1.00 '. $0.00 3y -:M....:A'l;F.v"'... "DESCRIPTION�xr `, ACCOUNTS i .. A".d°:% Q TY.AMOUNTr' 4€'PAID PAID`DATE. f' -Le *m .t Y r 4a."n PV SYSTEM- ARRAY, FIRST 20 .:1101-000042403 0 $24.17 $0.00 =nx PBY RE.C.E.I,P.T+P CLTD ;� +;04 ,, BY , ', f.ni>r°•'�..-„ ,+• . x4 - _,._ '�i".: ?., ?:,�Y sy. ;; '4 '�' f 'y -1 N°4-aT.k, bW-..-.o..-: P- .".i ! ,-O;..•U>a�: R.�.� f r. .v. .oDATE=CO i PV SYSTEM - ARRAY, FIRST 20 PC.. 101-0000-42600' 0 $24.17 $0.00 ?.: ..r�-t� �lri ti� :y Y r3�.'...* 5 :'yY�•"��,(y�:��'��'^S'�ID �3`�'q�R �V°'Y �Y. Tti _s'k�C.:4'Y, ��RY,q$,iY >, g ,�k ie'!�XfF�f��wrg if Ys3�R'�2k.. ...'✓�kiu `'!W CHECK #. �.,...n,:" CLTD t.F_METHOU�s„ RECEIRT�#k� BY ; .? ! r, a2""v: h� : < :..:.>,. ;r rY .;�tS n'" ' DESCRIPTION : " ✓' '` 5r r�C.:�'n'F> f'>', eta A ✓,. kx..+.? ACCOUNT ���p� ' TY AMOUNT ��*PAID e 'PAID,DATE ,, �> 'r, a'..Y...�,<,. � ,,. Y+'. ..,.. �, it • . t.e PV SYSTEM - MISC EQUIPMENT 101-0000-42403 0 $24.17. $0.00 ,`%Y3Y. :T'f y - :l'•..�.; 53- k.-K.(.$,Y'�lfY4.5. {' r PAID'tBY,� `;R�Z'•'s#.{,' .. 'EZ' to T' �. METHOD .. $'.zb.iv!'. Yid RECEIPT%#' ;,,. CHECK# 4� " �RCLTD'BY Y tia.�,�,Y.._r,, ,r ' i,.mrx,�:�u�. �.-P -.s_�. "��lu . sE,� DESCRIPTIONS �.� ACCOUNT�tAMOUNTa rnt P. Al PAIDfDATE. 5 -r.r.,. i Yk J q �'st . R P,. .r,... .ar nM�'-4" ��C ,va„r� .a - ;.s. "* i4diz 8.3' :�." w�' wv Sk..S"'a.uLTFr`..,.C�.�M�"`:i .'Ss c.. x._ .. .� - r, z3 Yjf R .�,--`�, i'S ,. .a:Y,... Y s^ _ : ^'§k J - etss+45 a : NJ c�.I l'.. PV SYSTEM-- MISC EQUIPMENT PC 101-0000-42600 0 $24.17 $0.00. j� r* PAID BY �f����PMETHOD� g �.ni x RECEIPT # + sCHECK # CLTD BY x : INFIRM rn �. Total Paid for ELECTRICAL:' $96.68 $0.00 r `�° DE s Rl TIS z', SC P ON- ,�:.,: ACCOUNT�;QTYY AMOUNTS, _ • a'w PAID PAID DATES d a, q -.. s�v,..'.� ��° . q ..;3 .. K<:: PERMIT ISSUANCE �' ' : 101-0000=42404 0 $91.85.-. $0.00 P '�'s- k.t.. "JY 't 4i 4 -�-e 4 q:. ��'F,'.:{.j"7C""3i..J �h"1' i°}Ye PAID BY�a Lh° a'c>rx; 'tu4 z". Q�'-c'..wF<.s�' c,T y4Z3• Yux'l. i�z 'e" +°t%".lfi.� 5 q'IS "� Pyr'p .9 RECEIPT # �$ { A > fY CHECK #f i� CLTD BY c ..'jar„ €x�,r+' . r3�aETHODa� _S ga x:. Total Paid • for PERMIT' ISSUANCE: $91.85 $0.00 Description: CHYLIK RESIDENCE SOLAR INSTALL Type: SOLAR Subtype: Status: APPROVED Applied: 7/7/2015 EVA Approved: 7/22/2015 JFU Parcel No: 773114012 Site Address: 51725 AVENIDA DIAZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 24 Lot: 4 Issued: UNIT 2 CI Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $21,083.40 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 STAFF NAME Details: 9.54 kW SOLAR ARRAY- (36) 265W KYOCERA KU2656ZPA PANELS W/ (1) ABB PVI-3.6-OUTD-US-Z-A INVERTER AND (1) ABB PVI-5000- OUTD-S-US-Z-A INVETER + 125A SUBPANEL [648SF) 2013 CALIFORNIA ELECTRICAL CODE. Printed: Wednesday, July 22, 2015 4:10:55 PM 1 of 3 CPE7E7 symms ADDITIONAL CI • • • CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE ,..... ....-w .,, .... NOTES NOTIFIED ELENA W/ SOLAR CITY THAT PLAN REVIEW WAS E-MAIL JAKE FUSON 7/8/2015 7/8/2015 COMPLETE AND REVISIONS WERE REQUIRED. SENT REDLINES AND CORRECTION LIST VIA EMAIL. PLAN CHECK PICKED UP MARY FASANO 7/14/2015 7/14/2015 NOTIFIED ELENA W/ SOLAR CITY THAT PLANS WERE TELEPHONE CALL JAKE FUSON 7/22/2015 7/22/2015 APPROVED AND PERMIT WAS READY TO ISSUE. CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL '"""'' APPLICANT SOLARCITY CORPORATION 3055 CLEARVIEW WAY SAN MATEO CA 94402 mplasse@solarcity.com CONTRACTOR SOLARCITY CORPORATION 3055 CLEARVIEW WAY SAN MATEO CA 94402 mplasse@solarcity.com Printed: Wednesday, July 22, 2015 4:10:55 PM 1 of 3 CPE7E7 symms FINANCIAL • •• CLTD DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE RECEIPT '# CHECK #' METHOD. PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $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 $0.00 TOTALS:• •0 PARENT PROJECTS w -A- 1 w,ATrt Printed:- Wednesday, July 22, 2015 4:10:55 PM' 2 of 3 CRWSYSTEMS REVIEW TYPE REVIEWER SENT DATE DUE DATE DATE STATUS REMARKS NOTES NON -STRUCTURAL - ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME JAKE FUSON 7/7/2015 7/14/2015 7/8/2015 REVISIONS REQUIRED SEE 1ST REVIEW. 1 WK DOC 7/8/2015 JAKE FUSON 1ST REVIEW REVIEW NON-STRUCTURAL - JAKE FUSON 7/20/2015 7/27/2015 7/22/2015 APPROVED . 1 WK 7/8/2015 JAKE FUSON 1ST REVIEW REDLINES BRES2015-0094 -1ST 0 Printed: Wednesday, July 22, 2015 4:10:55 PM 3 of 3 0?WlYSTEMS ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED BRES2015-0094 -1ST DOC 7/8/2015 JAKE FUSON 1ST REVIEW REVIEW 0 CORRECTIONS CORRECTIONS.pdf DOC 7/8/2015 JAKE FUSON 1ST REVIEW REDLINES BRES2015-0094 -1ST 0 REVIEW REDLINES.pdf Printed: Wednesday, July 22, 2015 4:10:55 PM 3 of 3 0?WlYSTEMS Bin. # City. Of La Quin: to BulkUng 81 Safety Division P.O. Box 1504,'78-49S Calle Tampico IA.Quinta, CA 92233 - (760) 777-7012 0Cq Building Permit Applicatlon and Tracking Sheet Permit # 5� I75. ' Project Add a Z owner's Name:. A P. Number. Address:.. Legal Description: City, ST, Zip: La Quinta, CA Contractor Solar City Telephone: Address: 3055 Clearview Way. ProjeetDescription: roof mounted77-. city, sT, zip: San Mateo, CA, 94402 inverter(s) Telephone: 650-638-1028 ' State Lia # : 888104 City Lie. #, Arch., EW., Designer: Address: City., ST. Zip: Telephone: State Lia #: NameofconwPerson:Elena Loya Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Scl.Ft.: #Stories: #Unit$: Telephone # of Contact Person: ( Estimated value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRACKING PERhIIT FEES Plan Sets Plan Check submitted Item Amount Structural Calea. Reviewed, ready for corrections 7/g Plan Check Deposit • . Truss Calce. Called Contact Person % Plan Check Balance. Title 24 We& Plans picked up Construction Flood plain plan Plans resubmitted •' . Mechanical Grading plan Z'! Review, ready for correction / ZZ Electrical Subcontactor List Called Contact Person 15,-tij A I Plumbing Grant Deed Plans picked up S3LL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for correctionaili sue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. take. Appr Date of permit issue School Fees Total Permit Fees