11-0094 (SOL)ft—- -4,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000094
Property Address:
4.7795 DUNE PALMS RD
APN:
600 -020 -041 -
Application description:
SOLAR
Property toning:
REGIONAL COMMERCIAL
Application valuation:
28697
T4ht 4 4 4"'
Applicant: Architect or Engineer:.
Lrarraarrrvlc. UA
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provision&of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License:is in full force and effect:
License Class: B CIO C46 Ucense.No.: 910836
XDate: I f Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the,Coriractor'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 applicam;for the
permit 'to'file a signed;statemertthat he or sheds licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing wWSection 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 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 notapply 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 of improvementis 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.).
(_ 1 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',w_ith a.centractor(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 penaltyof perjury that.there is a construction lending regency for the performance of the.
workfor which this permit is issued ISec. 3097, Civ. C.)•
Lender's Name: _
Lender's Address:
LQPERMff
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/25/11.
Owner:
COACHELLA VALLEY HOUSING COAL
45701 MONROE ST 1- A
INDIO, CA 92201
s
SAN 2 2011
Contractor:
RENOVA ENERGY CORP CITYCFs•A::.lf1PITA
75181 MEDITE AVENUIF1*2r?-,'`�E 3`FRIT
PALM DESERT, CA 92211
(760)568-34.13
Lit:. No.: 910836
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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 the work for which this permit.is
issued.
_ I have and will maintain workers' compensation insurance; asrequired by Section 3700 of the Labor
Code, for the performance of the work for which this permit.is.issued. My workers' compensation
insurance carrier and'.po(icy. number are:
Carrier NORGUARD INS Policy Number REWC128450.
_ I certify that, in the performance of the<work:for which this permit is Issued, l 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
3700 of the Labor Code, I shell forth rith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WdR” S' COMPENSATION COVERAGE 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 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 permit subject to the
conditions and restrictionslsetforth 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 Ouinta; 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 H work is not commenced
within 180:days from date of'issuanoe of such permit, or cessation of work for 180 days will subject
permit.to cancellation.
I certify that 1 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 county to enter upon the:above-mentioned;property for inspectlon purposes.
)(Date: + / nature (Applicant or. Agent): i
Application Number . . . . . 11-00000094
Permit . . . SOLAR PERMIT
Additional desc .
Permit Fee . . . . 19.50 Plan Check Fee
4.88
Issue Date . . . Valuation . . .
. 28697
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_.5.0 Plan Check Fee
5.63
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
7.50
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Special Notes and Comments
- -
4.86kW PV SYSTEM - (18) 270W PANELS W/
(1)SOLECTRIA PVI 5000 INVERTER [376SF]
2010 CALIFORNIA ELECTRICAL CODE.
[BUILDING: 8400 - CARPORT: 181
January 25, 2011 10:56:51 AM AORTEGA
-----------------.-_--------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid Credited
Due
---------- ---------- - -- _ ----------
Permit Fee Total 42.00 .00 .00
42.0.0
Plan Check Total 10.51, .00 :00
10:5:1
Other Fee Total 2.00 .00 .00
2.00
Grand Total 54.51. .00 .00
54.51
LQPERMU