BSOL2017-000978-495 CALLE TAMPICO 4.4 aHMUCl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
_ I have and will maintain a certificate of consent to self -insure for workers'
BUILDING PERMIT
Application Number:
BSOL2017-0009
Property Address:
79190 LAURIE CT CT
APN:
604343006
Application Description:
ZYSK/5.04 kW PV SYSTEM - (18) 280W PANELS/(1) INVERTER
Property Zoning:
OWNER -BUILDER RA ION
Application Valuation:
$25,200.00
Applicant:
FREEDOM SOLAR SERVICES DBA FREEDOM SOLAR
30605 SORREL LANE
CANYON LAKE, CA 92587
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
ROBERT PATERSON .
Contractor:
FREEDOM SOLAR SE
30605 SORREL LANE
CANYON LAKE, CA 9;
(951)321-0855
Llc. No.: 982892
Date: 5/16/2017.
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of -perjury that 1 am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and
_ I have and will maintain a certificate of consent to self -insure for workers'
my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C10, B. C39, C46 License No.: 98-1,89
of the work for which this permit is issued.
11
F'I have and will maintain workers' compensation insurance, as required by
(pate.` / Contractor:-- /her
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:
OWNER -BUILDER RA ION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9052248
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State
_ I certify that in the performance of the work for which.this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers' '
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires.the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
statement that he or, she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
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 c
_Date.' j! / Applicant
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).:
WARNING: FAILURE TO SECURE WORKERS' CONSATION COVERAGE 15 UNLAWFUL,
( ) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(� I, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(� I am exempt under Sec. . 8.&P.C. for this reason
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
Date: Owner:
for 180 days will subject permit to cancellation.
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 Name:
Lender's Address:
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 relating to building
construction, and hereby authorize representatives of this city tor pon the above-
mentioned property for inspection purposes. _ en ' //
Date:` G Signature (Applicant or Agent):
Date: 5/16/2017
Application Number: BSOL2017-0009
Owner:
Property Address: 79190 LAURIE CT CT
ROBERT PATERSON
APN: 604343006
Property Zoning:
Application Valuation: $25,200.00
Applicant:
Contractor:
FREEDOM SOLAR SERVICES DBA FREEDOM SOLAR
FREEDOM SOLAR SERVICES DBA FREEDOM SOLAR
30605 SORREL LANE
30605 SORREL LANE
CANYON LAKE, CA 92587
CANYON LAKE, CA 92587
(951)321-0855
-----------------------------------------------------------------------------------------------
Llc. No.: 982892
Detail: 5.04 KW SOLAR ARRAY - (18) 280W CANADIAN SOLAR CS6K-280M PANELS + SOLAREDGE P300 OPTIMIZERS W/ (1) SOLAREDGE SE3800H-US
INVERTER [324 SFJ 2016 CALIFORNIA ELECTRICAL CODE.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $2.00'
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PV SYSTEM LESS THAN 1OKW
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PV SYSTEM LESS THAN 10KW PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00