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