BSOL2017-002678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
PACIFIC GREEN HOMES INC
14530 HAMLIN ST #C
VAN NUYS, CA 91411
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/2/2018
SOLAR/RESIDENTIAL LESS THAN 10KW _ Owner:
BSOL2017-0026 REGINALD JACKSON
52400 AVENIDA VALLEJO 52400 AVE NIDA VALLEJ0
,773263008 LA QUINTA, CA.92253
JACKSON / 7.2kW PV SYSTEM - (20) 360W PANELS/(1) INVERTER
$7,000.00
PNo 2 2018 u 1
OF �QW DE PF(MENS
G1'N ELOPMEt�
GOMM1fN\1V D�1
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: B / License No.: 1008948
Contractor;
• T-
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 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 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 Address:
Contractor:
PACIFIC GREEN HOMES INC
14530 HAMLIN ST #C
VAN NUYS, CA 91411
(818)30175354
Llc. No.: 1008948
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
Df the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3 00 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: 9156594
_ 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 that, if I should become subject to the
workers' compensation provisions of Section 3.700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' 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 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 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 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.
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
constfuction, and hereby authorize representatives of this city.to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 1/2/2018
Application Number: BSOL2017-0026.
Owner:
Properry,Address: :32400 AVENIDA VALLEJO
REGINALD JACKSON
APN: 773263008
52400 AVENIDA VALLEJO
Application Description: JACKSON./ 7.2kW PV SYSTEM - (20) 360W PANELS/(1) INVERTER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
Applicant:
Contractor:
PACIFIC GREEN HOMES INC
PACIFIC GREEN HOMES INC
14530 HAMLIN ST #C
14530 HAMLIN ST #C
VAN NUYS; CA 91411
VAN NUYS, CA 91411
(818)301-5354
Llc. No.: 1008948
Detail: 7.2 kW SOLAR ARRAY - (20) 360W SiLFAB SLG 360M PANELS + P-400 POWER OPTIMIZERS W/ (1) SOLAR EDGE SE-6000Ff-US INVERTER [400SF]
2016 CALIFORNIA ELECTRICAL CODE.
FINANCIAL INFORMATION
DESCRIPTION . ACCOUNT QTY AMOUNT .
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PV SYSTEM LESS THAN 10KW
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PV SYSTEM LESS THAN 10KW PC
101-0000-42600
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
$10.00
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:
solar -••
SolarEdge Power optimizer
Module Add -On For North America
P320 / P400 /
PV power optimization at the module -level
— Up to 25% more energy
— Superior efficiency (99.5%)
- Mitigates all types of module mismatch losses, from manufacturing tolerance to partial shading
— Flexible system design for maximum space utilization
— Fast installation with a single bolt
Next generation maintenance with module -level monitoring
— Module -level voltage shutdown for installer and firefighter safety
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