11-0087 (SOL)Ailw-, - , �_v
P.O. BOX .1504
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
Application Number: 11-0'0000087
Property Address: 47795 DUNE 'PALMS RD
APN: 600-020-041- -
Application description- SOLAR
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 115943
T41Y 4 4 09ha
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penalty of perjury.that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of, Division 3 of the Business and Professionals Code, and my. License is.in full forowand effect.
License Gass: B C10 C46 License No : 910836
x Date: I) Contractor:
OWNER- CLARATION
I hereby affirm under penalty of perjury the 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 e!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 purauant.to the provisions.of the',Comractor'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 penaftyof 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•doas the work himself or herself through his or, own employees; provided'that,the
improvements are narintended 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
improveforthe 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 doesnotapply-to an owner of
Property who builds or improves thenion, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( _.1 1 am exempt under Sec. , B.6P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of. perjury that there is -a construction lending agency for ths'performance of. the
work.for. which this permit is issued (Sec. 3097, Civ: C.).
Lender's,Name:-
Lender's Address:
LQPSRMIT
VOICE (760) 777-7012
FAX (760) 777-701,1
INSPECTIONS (760) 777-7153
Date: 1/25/11.
Owner:
COACHELLA VALLEY HOUSING COALI
4570.1 MONROE ST 1-G'
IND.IO, CA 92201 D
Contractor:
JAN .2 ZGii
RENOVA ENERGY CORP
75181 MEDITERRANEAN A E CITyr:P j,/q Quil1;
�
F!�lfr
PALM DESERT, 'CA 92211
(760)568-34-13
Lic. No.: 910836
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WORKER'S - COMPENSATION ' DECLARATION
I herebyaffirmunder 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 3706 of the Labor
Code, for the.perfomiance of the work for which this permit is issued. Myworkers' compensation
insurance carrier and policy number are:
Carrier NORGUARD, INS Policy Number REWC128450
_ I certify that, imthe performance of, the work for 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
of the Labor Code, I sit 1 fo twit omply with,those provisions.
Dater Z ry Applicant:
WARNING: FAILURE TO`SECURE PIKERS' COMP.ENSATIO VERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000). IN ADDITION TO THE COST OF COMPENSATION„DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application.is hereby made to the Director of..Building and Safety for a permitsubject to the
conditions and restrictions.set,forth on this application.
1. 'Each person upon Whose behalf this application Wmade, each person at whose request and for
whose.benefit-work,is performed:underor pursuant to any permit issued as a result of this application,
the owner,.and;the applicant, each agreesto,<and shall defend, indemnify and hold harmless the City
of La Quints, its officers,.agents and employees for any act or omission related toithe work,being
performed: under or following issuance of this permit.
2. Any permit issued es.a result of this application becomes null and void if work isnot 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 theabove information •iscorrect. l.agree.to comply+with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to. en pr upon the above-mentioned_property !or inspectio urposes:
XDate: f Z.S OSignsture (Applicant or.Agent):
Application Number . . . . 11-00000087
Permit SOLAR PERMIT
Additional desc .
Permit Fee . . . . 19.50 Plan Check Fee
1.22
Issue Date . . . Valuation . . .
. 15943
Expiration Date 7/24/11
Qty Unit Charge Per
'Extension
BASE FEE
15.00
1.00 4.5000 EA SOLAR COLLECTOR < 1000
4.50
Permit . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 22.50 Plan Check Fee
1.41
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 7/24/11
Qty Unit Charge Per
Extension
-BASE FEE
15.00
1.00 7.5000 EA ELEC PWR APP >1 TO <=10
1.50
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Special Notes and Comments,
2.7kW PV SYSTEM - (10) 276W PANELS W/
(1) SMA SUNNY BOY 3000 INVERTER [209SF]
2010.CALIFORNIA ELECTRICAL CODE.
[BUILDING: 7200 - CARPORT: 151
*'**REDUCED PLAN CHECK FEE***
January 25, 2011 10:18•:12 AM AORTEGA
-------------------------------- - --- ----
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------------------------------------------
Other
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---
----------- ------ ---------------- -
Due
- - -- -
-
Permit. Fee Total 42.00 .00 .00
42.00
Plan Check Total 2.:63 .00 .00
2.6.3
Other Fee Total 1.00 .00 .00
1.00
Grand Total 45.63 .00 .00
45.63
LQPERMrr