BELC2019-006778-495 CALLE TAMPICO T4ta D / VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype:
ELECTRICAL/ Owner:
Application Number:
BELC2019-0067 JENNIFERZYSK
Property Address:
79190 LAURIE CT CT
APN:
604343006 LA QUINTA, 92253
Application Description:
ZYSK/TESLA POWER WALLAND PANEL UPGRADE
Property Zoning:
Application Valuation:
Applicant: D
Contractor:
ELITE ELECTRIC ELITE ELECTRIC
9415 BELLEGRAVE AVE 9415 BELLEGRAVE AVE
RIVERSIDE, CA 92509 JUN 18 2019 D RIVERSIDE, CA 92509
(951)681-5811
CITY OF LA QUINTA Llc. No.:418242
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C10 D1 License No.: 418242
Date: V -I 1 Contractor:
OWNER -BUILDER D ATION
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 Add
Date: 6/18/2019
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: CYPRESS INSURANCE COMPANY Policy Number: ELWC909139
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.
Date: I>; l ?) -1 of Applicant:
WARNING: FAILURE TO SECURE WORKERS'COM ZT105N COVERAG=SUNLA�WFU L,
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: k 5- 4 Signature (Applicant orAgen
Date: 6%184019
Application Number:
BELC2019-0067 Owner:
Property Address:
79190 LAURIE CT CT JENNIFER ZYSK
APN:
604343006
Application Description:
ZYSK / TESLA POWER WALL AND PANEL UPGRADE LA QUINTA, 92253
Property Zoning:
Application Valuation:
Applicant: Contractor:
ELITE ELECTRIC ELITE ELECTRIC
9415 BELLEG RAVE AVE 9415 BELLEGRAVE AVE
RIVERSIDE, CA 92509 RIVERSIDE, CA 92509
(951)681-5811
LIc. No.: 418242
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ - - - - - - ^ - - - - - - - - ' i - - " ' - ' - - - ' - - - - _ ' ' - - ' ' - - ' ' - - - ' ' - - - - ' - - _
Detail: ZYSK/ INSTALL NEW TESLA POWER WALL 2 ENERGY STORAGE SYSTEM TO EXISTING SOLAR PHOTOVOLTAIC SYSTEM TO SERVE NEW 200A CRITICAL
LOAD CENTER+ UPGRADE PANEL TO 225A. 2016 CALIFORNIA BUILDING CODES. ':i u ` !.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT PC
101-0000-42600
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
0
$13.34
Total Paid for ELECTRICAL: $146.74
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
Contractor Name:
Address:
City, St, Zip
Telephone: ct
Email:
State Lic; g1tN2-
��,�e; fie,
J�c Ack „r
C Ck-
City Bus Lic:
Architect/Engineer Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
iL New SFD Construction:
Conditioned Space
jCt Garage
Patio/Porch
Fire Sprinklers
Construction
Grading:
Bedrooms: I Stories:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
SF
SF
SF
SF
Occupancy:
# Units:
OFFICE USE ONLY
# � Submittal � Required � Received
Plan Sets
Structural Calcs
Truss Calcs
i
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
Jennifer Zysk
79190 Laurie Court
La Quinta, CA 92253
(760) 610-5626
To Whom it my Concern;
I grant Elite Electric permission to provide all of electrical work required on the residence
(listed above) for the installation of the Tesla Wall battery that is being purchased through
Swell Energy.
If there are any questions, please do not hesitate to contact me at the number listed
above.
Sincerely,
,LL <eljai
Jennifer K Zysk (property owner)
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