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BSOL2018-000178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation:. 4aw. DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT SOLAR/RESIDENTIAL LESS THAI BSOL2018-0001 51297 AVENIDA DIAZ 773043034 DEBOOM/11.21kW PV SYSTEM $13,900.00 Applicant: MOHR POWER SOLAR INC DBA 21ST CENTURY 50 1452 POMONA ROAD . CORONA, CA 92882 . LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that l 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 License No.: 661434 ftDa"t_ �� tor. OWNER-BUILDE RATION 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 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 84 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/10/2018 Owner: FRED DEBOOM 51297 AVENIDA DIAZ LA QUINTA, CA 92253 Contractor: MOHR POWER SOLAR INC DBA 21ST CENTURY 50 1452 POMONA ROAD 'CORONA, CA 92882 (951)736-2000 Llc. No.: 661434 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, as required 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 policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115206 I certify that in the performance of the 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 t if I should become subject to the workers' compensation provisions of Sectio 37 of the Labor C de, I shall forthwith comply w� those provisions. D� + "D ` -Applicant: WARNING: FAILURE TO SECURE WORKE OMPENSATION COVERAGE IS UNLAWFUL, 4ND 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT MPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose ,equest and for whose benefit work is performed under or pursuant to any permit ssued 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 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. CONSTRUCTION LENDING AGENCY I certify that I'have read this application and state that the above information is correct. I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances and st aws relating to building . the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this ci t . enter upon the a ove m tinned property for inspection purposes. Lender's Name: _ p�- Date: ignatup, e (Applicant or Agent): . Lender's Address: t Date: 1/10/2018 Application Number: BSOL2018-0001 Owner: Property Address: 51297 AVENIDA DIAZ - .. FRED DEBOOM APN: 773043034 51297 AVENIDA DIAZ Application Description: DEBOOM/11.21kW PV SYSTEM - ADD (8) PANELS TO EXISTING SYSTEM LA QUINTA, CA 92253 Property Zoning: Application Valuation: $13,900.00 Applicant: Contractor: MOHR POWER SOLAR INC DBA 21ST CENTURY SO MOHR POWER SOLAR INC DBA 21ST CENTURY SO 1452 POMONA ROAD 1452 POMONA ROAD CORONA, CA 92882 CORONA, CA 92882 (951)736-2000 Llc. No.: 661434 Detail: ADDITION TO EXISTING PHOTOVOLTAIC SYSTEM. ADD (8) TSEC TS60-6M3-295 PANELS W/ ENPHASE IQ6-60-2-US MICROINVERTERS TO EXISTING SYSTEM RESULTING INA 11.21kW SOLAR ARRAY. MAIN BREAKER MUST BE DERATED PER PLAN. [684SF).2016 CALIFORNIA ELECTRICAL CODE. oil FINANuAL NFORMATION DESCRIPTION ACCOUNT QTY i BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STAN DARDS•ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PV SYSTEM LESS THAN 10K,W 101-0000-42403 0 $26.01 DESCRIPTION _ ACCOUNT QTY AMOUNT. PV SYSTEM LESS THAN 10KW PC 10170000-42600 • 0 $26.01 Total Paid for ELECTRICAL: $52.02 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: '$98.83 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.60 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT- QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: