BSOL2015-0160. 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 Class: C46, B C10 A C20en o : 888 0
Date: Contractor:
OWNER -BUILDER DECLARATION
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 COMPENSA70N DECLARATION
I hereby affirm under penalty of perjury one on the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compe sation, as provided for by Section 370C of the Labor Code, for the performance
t rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se n 700 of the Labor Code, for the perfor •nance of the work for which this permit
is issued. My workers' compensation insuranc2 carrier and policy number are:
Carrier: Polity Number: _
I certify that in the performance of :he 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 Se 1 3700 the Labor Code, I shall forthwith
comply w h t o$e�covisions.
Date: ��(JJpp Applicant:
WARNING: FAILURE TO. SECURE WORKERS' CO JIPEN TION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT_AN EMPLOYER TO CRIMINAL PENALTIES, AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00)). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOF 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 thi! 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 Zity of La Quinta, its officers, agents, and
employees for any act or omission related to t9 a work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appliotion 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 cancel ation.
I certify that 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 relAiog to building
construction, and hereby authorize representa:ives of this city a ter up n the above-
mentiopg; p rCy for inspection purposes. ( "
Dater//{�y �(/,,� Signature (Applicant or Agent):
C�
4P
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:
9/9/2015
Application Number:
BSOL2015-0160 -
Owner:
Property Address:
54645 AVENIDA CARRANZA
DAWN BERGER
AM:
774274018
54645 AVENIDA CARRANZA
Application Description:
BERGER/4.77 kW PV SYSTEM - (18) 26SW PANELS/(1) INVERTER
LA QUINTA, 922E3
0
Property Zoning:
Application Valuation:
$10,541.70
c
v�
m
Applicant:
Contractor:
E3
C
SOLARCITY CORPORATION
SOLARCITY CORPORATION
?
C9
3055 CLEARVIEW WAY
3055 CLEARVIEW WAY
tv
ATTN ZOE STEELE
ATTN ZOE STEELE
a
cit
SAN MATEO, CA 94402
SAN MATEO, CA 94402
9
(650)963-4722.
M
M
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 Class: C46, B C10 A C20en o : 888 0
Date: Contractor:
OWNER -BUILDER DECLARATION
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 COMPENSA70N DECLARATION
I hereby affirm under penalty of perjury one on the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compe sation, as provided for by Section 370C of the Labor Code, for the performance
t rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se n 700 of the Labor Code, for the perfor •nance of the work for which this permit
is issued. My workers' compensation insuranc2 carrier and policy number are:
Carrier: Polity Number: _
I certify that in the performance of :he 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 Se 1 3700 the Labor Code, I shall forthwith
comply w h t o$e�covisions.
Date: ��(JJpp Applicant:
WARNING: FAILURE TO. SECURE WORKERS' CO JIPEN TION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT_AN EMPLOYER TO CRIMINAL PENALTIES, AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00)). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOF 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 thi! 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 Zity of La Quinta, its officers, agents, and
employees for any act or omission related to t9 a work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appliotion 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 cancel ation.
I certify that 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 relAiog to building
construction, and hereby authorize representa:ives of this city a ter up n the above-
mentiopg; p rCy for inspection purposes. ( "
Dater//{�y �(/,,� Signature (Applicant or Agent):
1
:, , .• a" 'DESCRIPTION`..a�" ,.''
FINANCIAL ••.
;tea •#ACCOUNT
QTY,'" ;AMOUNT E.;�`
PAID PAID DATE'
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$0.00
'•PAID,BYr :.
} ^METHODa , ..,
RECEIPT # ' '
CHECK # w
CLTD BYw
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION{''f <�
`' ¢";",,� ACCOUNT F° <5* .:
QTY,
AMOUNT,:
' PAID
=PAID DATE
PV SYSTEM - ARRAY, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY x;; r' . , ,
<• METHOD'`
+ 'RECEIPT,#
CHECK# £ °M
4 hCLTD BY-,
a g ,
RIPTION
. ,&
QTY
AMOUNT
'PAID'
;PAID DATE
PV SYSTEM - ARRAY, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
r 'PAID BY• �.` ,,• Y =
' } METHOD ' , . , "•
w `' RECEIPT # , i_
CHECK #-
CLTD BY
Total Paid forELECTRICAL: $48.34 $0.00
s L DESCRIPTION
b ACCOUNT4 <
`QTY
F AMOUNT'
rPAID
'PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
x PAID BY . 1_'
METHOD",
y RECEIPT # . i
CHECK #
CLTD BY
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
DPSrriptinn• RFRGFR/4 77 kW PV W1,TFM . (1R) 7F51Al PANELS/(1) INVERTER
Type: SOLAR Subtype: Status: APPROVED
Applied: 8/28/2015 AZA
Approved: 9/8/2015 JFU
Parcel No: 774274018 Site Address: 54645 AVENIDA CARRANZA LA QUINTA,CA 92253.
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 308 Lot: 7
Issued:
UNIT 28
. ,..
;, CONiPLETION':DAT,E..:'
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $10,541.70Occupancy Type: Construction Type:
Expired:
No. Buildings: 0- No. Stories: 0 No. Unites: 0
Details: , 4.77 kW SOLAR ARRAY - (18) 265W KYOCERAKU2656ZPA W/ (1) ABB PVI-3.6-OUTD-US-S-Z-A INVERTER [324SF) 2013 CALIFORNIA
ELECTRICAL CODE.
d r -
ADDITIONAL SITES
FINANCIAL INFORMATION "
Printed: Wednesday, September 09, 2015 1:27:52 PM 1 of 2 sysrrnas
CHRONO'ILOGY
CHRONOLOGY -TYPE STAFF NAME
ACTIONFDATE
. ,..
;, CONiPLETION':DAT,E..:'
.� '. , R r.�.. ::. :f ., d., ..:.
S 1. .:i Y . -i....: ..» • . A'... i...>..._
,. . ..e .wF'. ..':. :, .. 'Xt %�>S.aAk:`,Y 3': A_4'. in:.M>r . ..:*M+u- L <'s'n nY....".:. 'F
NOTIFIED ELENA W/ SOLAR CITY THAT PLANS WERE APROVED
E-MAIL
JAKE FUSON
9/8/2015
9/8/2015
AND PERMIT WAS READY TO ISSUE.
CONDITION
CONTACTS
NAME.
f NAME
AQDRESSi
CITY STATE a PRONE FAX EMAIL
-, ..
.
z
- _ZIPrc
sem:
APPLICANT
SOLARCITY CORPORATION
3055 CLEARVIEW WAY
SAN MATEO CA
94402 (951)525-2007
CONTRACTOR
SOLARCITY CORPORATION
3055 CLEARVIEW WAY
SAN MATEO CA
94402 (951)525-2007
OWNER
DAWN BERGER
54645 AVENIDA
LA QUINTA
92253 (951)525-2007
CARRANZA
FINANCIAL INFORMATION "
Printed: Wednesday, September 09, 2015 1:27:52 PM 1 of 2 sysrrnas