14-0323 (SOL)P.O. BOX 1504
Tht4 :&Q"
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 14-00000323 Owner:
Property Address: 61532 FIRE BARREL DR ROBERTS DOREEN P
APN: 764-500-006- 61532 FIRE BARREL DR
Application description: SOLAR LA QUINTA, CA 92253
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 23000
Contractor:
ApI lipant: Architect ?rf-ngineer: BELMONT ENERGY
27441 MONFORTE
MISSION VIEJO, CA 92692
(949)793-5544
Lic. No.: 963824
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/07/14
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Ch ter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professional, lode,,nd s full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License C [as 96,82s
s: C10 C46 License "
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
i ssued.
Date: S/ -7—T— Contractor:
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
Oyy ER-BUII DER DEC ' TION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE -FUND — Policy Number 9046646-2013
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to tha_%w&ker*veFRpVsation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labo kCV597T`sh'�forthwit),e0?5pIy with isions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
e—
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: Applicant:
1, 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
WARNING: FAILURE TO SECINE WORKERV COMPE TION COVERAGE IS UNLAWFUL, AND SHALL
E�Co_p T'O' C
�CIVIl
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PEIALIIE AND 1IONVES UP TO ONE HUNDRED THOUSAND
S
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed 'under or pursuant to any permit issued as a result �f this -Application,
I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 Name:
Lender's Address:
LQPEPNIIT
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 agi eq_1 o �mp I y w i l 7h�a V
city and county ordinances and state laws relating to b ild' n t'uct . on, and hereby a rize repres tat
of this county to enter upon the above-mentioned pro
p:��yior �msp.c on I
Date Signature fApplicant or
Application Number
Permit . ... . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 14-00000323
ELECTRICAL 2013
23.83 Plan Check Fee .
Valuation . . .
11/03/14
00.
0
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC DEVICES,
FIRST 20
23.83
-----------------------------------------------------------
Special Notes and Comments
7 ----------------
6.6kW SOLAR ARRAY - (24) 275W SUNMODULE
PANELS W/ (24) M250 ENPHASE MICRO
INVERTERS [408SF] 2013 CALIFORNIA
ELECTRICAL CODE.
May 6, 2014 9:54:38 AM AORTEGA.
---------- ---------- -------------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1�100'
PLAN CHECK,
ELECTRICAL
23.8�
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid
Credited
Due
----------------- ---------- ----------
Permit Fee Total 23.83 .00
---------- ----------
.00
23.83
Plan Check Total .00 .00
.00
.00
Other Fee Total 115.40 .00
.00
115.40
Grand Total 139.23 .00
.00
139.23
LQPERMIT
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city., La Q
Bdlaft 8r Saky DWon
P.O. Box 1504,"78-495 Calle Tampico
La.Q*ta, CA 92253 -:(760) 777-7012
Building Permit -Application* and Tracking Sheet
Permit #
4-32-3,
Praj=Add=-:615?2-WX Zx� Ltee&=,bal t r,—=
Owner's Nwne-
A-P.'Number . . . . . . . . . . .
Address: Q53,7 -
Legal Desaiption 1: gj6j-7 -rlz W� -5
22, 81, z'P- LA ii, 061 Ty A
Contractor.'�3�7tmc>>-�% VFP��
Telephone:
PMieq Description:
Address: RQVr—QAe73Vr
City, �T, Zip: V,
Telephorw. ?s 3;74J4/* I
State Lic. U %39Z City Li c-
Arch, EaV., Designer.
Address: 1337977&6wiD MK��J�
gA2jp Um&w- WvQWA.
City., SL ziplyou rl" 1-4. 1/97 4?-
Teliphoae: 805" Z/00
..... .....
State Lic. #: SZ/4 /I
Construction T�pe: O=pancy: AgS
Project rfpc (circle one): 'New Add'n.,�o Repair Demo
Name of Contaq Person: 4, .
Sq. Ft.:
# Stories:
uniu;:
Telephone 4 of Contact Person:
J_EstimatcxJVa1ieof jectd,;?-_3,VC-P
Pro
APPLICANT: DO NOT WWM BELOW THIS LINE
0
'Submittal
Reqld
'Recd
TRACKMG PERb=FEES-
Pion Sets
Plan Check submitted I&M Amount
Strqduftl Cities.
RMeW4 ready for corrections Plan Check Deposit.
Truss Cake.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans pick�d up Ve Construction
Inood plain a*
PLO
Plans resubmitted.'. Mcbfilcl
Grading plan
2,*� Review, ready for correctioWmue Electrical
Subcontactor List
Called ContactPerson Pl�mblg
Grant Deed
Plans picked up sd�u
ELOA. Approval
Plans resubmitted Grading
'U4 HOUSE -1
WView's ready for eormtl4Q) -1// eveloper Impaq Fee
PlanningAliproval.
Called Contact Person A
Pub. T�ks. Appr,
Date of permit issue
School Fees
t Fees
Total Permit Fees
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