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BSOL2019-0004D � QU440 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 {commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: B C10, C46. C39 License No.: 1029644 of the which this permit is issued. I have and will maintain workers' compensation insurance, as required by 411flion 3700 of the Labor Code, for the performance of the work for which this permit tis issued. My workers' compensation insurance carrier and policy number are: Carrier: RE_OWOOD FIRE AND CASUALTY INSURANCE CO Policy Number: PRWC011614 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 3700 of the Labor Code, I shall forthwith comply with those provisions. _ 78-495 CALLE TAMPICO VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/21/2019 Permit Type/Subtype: SOLAR/RESIDENTIAL LESS THAN SOKW Owner: Application Number: BSOL2019 0004 NORI EGA MARK A / SAY Yi� R_e Property Address: 78545 SAGUARO DR 78345 SAGUARO ROAD. APN: 646313004 LA QUINTA, CA 92253 Application Description: YI/10.88 kW PV SYSTEM - (34) 320W PANELS/(1) INVERTER `� Z Property Zoning: Application Valuation: $34,000.00 � tl Applicant: Contractor: �. p L �� <!, L L' FREEDOM FOREVER LLC FREEDOM FOREVER LLC a � � f li 43445 BUSINESS PARK DR STE 110 43445 BUSINESS PARK DR , STF�— 111 TEMECULA, CA 92590 TEMECULA, CA 92590. CO-1-71 F. (888)557-6431 Llc. No.: 1029644 3-a-1- r 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 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 Name: Lender's Address: Dater `2L I- ! ._ 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 construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Date: Z 1 / Signature (Applicant or Age Date: = 3/21/2019 Application Number: BSOL2019-0004 Property Address: 78545 SAGUARO DR APN: 646313004 Application Description: YI/10.88 kW PV SYSTEM - (34) 320W PANELS/(1) INVERTER Property Zoning: Application Valuation: $34,000.00 Applicant: FREEDOM FOREVER LLC - 43445 BUSINESS PARK DR STE 110 TEMECULA, CA 92590 Owner: NORIEGA MARK A / SAY YI 78345 SAGUARO ROAD LA QUINTA, CA 92253 Contractor: FREEDOM FOREVER LLC- 43445 BUSINESS PARK DR STE 110 TEMECULA, CA 92590 (888)557-6431 Llc. No.: 1029644 Detail: 10.88 kW SOLAR ARRAY - (34) 320W LG LG320N1K-A5 PANELS + SOLAREDGE P320 OPTIMIZERS W/ (1) SOLAREDGE SE760OH-US INVERTER [612 SF] 2016 CALIFORNIA ELECTRICAL CODE. DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $2.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 DESCRIPTION ACCOUNT CITY AMOUNT PV SYSTEM LESS THAN 10KW 101-0000-42403 0 $26.68 DESCRIPTION ACCOUNT QTY AMOUNT PV SYSTEM LESS THAN 1OKW PC 101-0000-42600 0 $26.68 Total Paid for ELECTRICAL: $53.36 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 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 X-a aka G.'A ofrh, DFSEKI' — Project Address: ;L APN #: Applicant Name-10:7� jk e—/1e-p-12 Address: 3 T 7 ' l J-e Y City, ST, Zip: Telephone: Email: rn Contractor Name: Address: Ll 7 "F, u :) City, St, Zip Telephone: %Y1 23 7 41% 6 Email: f•yI Cyv��'��[7►•:n��^�-e.l�.�` � S atel be: 11-f2 City Bus Lic: 7tnU X, V �— Arch/Eng Name: Address: City, St, Zip Telephone: Email: State Lic: City Bus Lic: Property Owner's Name: Y, L-�C_ L Address: v ��,d City, ST, Zip �U l �1Fji g i Telephone: '�pb �" eV •, nj�-�____ Email: PERMIT # PLAN LOCATION: Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech P1 I _U:_�11YV LWC) l.� Valuation of Project S 3Yj 0 New SFD Construction: Conditioned Space Garage Patio/Porch Fire Sprinklers Construction Type: Grading: Bedrooms: Stories: SF SF SF SF Occupancy: # Units: New Commercial / Tenant Improvements: Total Building SF Construction Type: Occupancy: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # I Submittal I Req'd 1 Ree'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License