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11-0091 (SOL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: .Property Zoning: Application valuation: Applicant: 11-000.00091 - 47795 DUNE PALMS RD 600-020-041- - SOLAR •REGIONAL COMMERCIAL 79716 Architect or Engineer: x14 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: COACHELLA VALLEY 45701 MONROE ST INDIO, CA 92201 VOICE (760) 777-7012 FAX (760) 777-701.1 INSPECTIONS (760) 777-7153 HOUSING COALI 1-G Contractor: RENOVA ENERGY CORP 75181 MEDITERRANEAN AVENUE PALM DESERT, CA 92211 (760)568-3413 Lic. No.: 910'836 Date: 1/25/11 JAN 2 2011 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION Iherebyaffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I"hereby affirm,under penalty of perjury one of the following, declarations: Section 70001 of Division 3 of the Business;and Professionals: Code, and my License is in full force and effect. _ I have and will maintain a certificate of consemrto.setf4nsure for workers' compensation, as provided License:Cl ss: B C10 C46 .License No.: 910836 for by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. Date:. 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 OWNERS CLARATION insurance carrier and policy number are: I hereby>affirm under penalty of perjury that I'am exempt from the Contractor's State License Lew for the Carrier NORGUARD INS Policy Number REWC128450_ - 'following reason (Sec. 7031.5, Business and Professions.Code: Any city or county that requires a permitto _ I certify that;in the performance of the work for which this permit is issued, 1 shall not employ any construct, alter, improve, demolish, orsepair any structure, prior to its issuance,:also requires the applicant for the person in any manner so:asito becomesubject 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 the workers' compensatio ovisions of Section License Law (Chapter 9 (commencing with ,Section 7000) of, Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sI forthwith comply with. th a provisi 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 permtt,subjects the applicant to a civil penalty of not more than five, hundred dollars ($500).: jute: Z Applicant: (_ 1 I, as owner of the property, or my employeas-with wages as their. sole compensation, will do the work,: and the structure is not intended or offered forsala (Sec. 7044, Business and Professions Code: The A/ WARNING:" FAILURE TO SECURE WORKERS' COMPENSAT199 COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply. to an owner of property who builds,orimproves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND FINES UP TO ONE HUNaFtED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS (6100,000). 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEWS FEES.. one year of completion; the owner -builder will have the burden of proving that he or she did not build or improvefor 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, Low 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 oehalf'this application is'made, each person at whose requestand for pursuant tothe Contractors" State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of. this application, (_ 1 I"am exempt under Sec. , B.&P.C. for thisFreason the owner, and the applicant, each agrees to, and shall defend, indemndfyarehold harmless the. City Date:. Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penatty,of perjury that there is a construction lending agency for the perfovnance�of the work for which this permit isissued(Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address:. LQPERMIT of La Quints, its officers, agents and employees for any act or omission related to the work being performed under or following issuance;tif this permit. 2. .Any permk'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 certifythat I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,, and,hereby authorize representatives of.this' co ty to iter upon the above-mentioned property for inspection purposes. Date: ��/ Signature(Applicant'or.Agent): Application Number ... . . . 11-00000091 Permit . . . SOLAR PERMIT Additional desc . . Permit• Fee . . . . 22.50 Plan Check Fee 5.63 Issue. `Date . . . Valuation . . . . 79716 Expiration Date 7/24/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 7.5000 EA SOLAR COLLECTOR 1,00,1-2000 7.50 Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . Expiration Date . ELEC-MISCELLANEOUS 30.00 7/24/11 Plan Check Fee . . 7.50 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC PWR APP >10 TO <=50 15.00 --------------------------- ---------------------------------------- Special Notes and Comments --------- 13.5kW PV SYSTEM - (50) 270W PANELS W/ (1)'FRONIUS IG PLUS INVERTER [1,045SF] 2010 CALIFORNIA ELECTRICAL CODE. [BUILDING: 3300 - CARPORT: 41 January 2:5, 2011 10:31:03 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG.STDS ADMIN (SB1473) 4.00 Fee summary Charged Paid • Credited Due ------------------------------------- Permit Fee Total 52.50 .00 -------------------- .00 52.50 Plan Check Total 13.13 .00 .00 13.13 Other Fee Total 4.00 .00 .00 4.00 Grand Total 6:9.63 .00 .00 69.63 LQrRRnur