BSOL2014-0002LICENSED 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: C46, C1�0ff License No.: 915598 /
Date: - 1 Contractor:. 7'1Q'101'/� 6 wQ r
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:
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 rk for which this permit is issued.
0 1 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: _ Policy Number:
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:` r_ 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 building
construction, and hereby authorize representatives of this city to enter up th above-
mentioned property for inspection purposes.
Date: Z Z L Signature (Applicant or Agent):
c&t,,
4 Qum&
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA 4UINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/22/2014
Application Number: BSOL2014-0002
Owner:
Property Address: 77914 GREY WOLF TR
BRUCE IWAMOTO
APN: 623510007
;
Property Zoning:
R
Application Valuation: $45,000,00
a
�
Applicant:
N
Contractor: N 3
HELIOPOWER INC
HELIOPOWER INC p
AV N z
25747 JEFFERSON AVENUE
MURRIETA, CA 92562
25747 JEFFERSON
MURRIETA, CA 9256 a
(951)677-7755
LIc. No.: 915598
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: C46, C1�0ff License No.: 915598 /
Date: - 1 Contractor:. 7'1Q'101'/� 6 wQ r
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:
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 rk for which this permit is issued.
0 1 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: _ Policy Number:
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:` r_ 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 building
construction, and hereby authorize representatives of this city to enter up th above-
mentioned property for inspection purposes.
Date: Z Z L Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL •1•
ACCOUNT QTY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $2.00
$0.00
PAID BY
METHOD RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PV SYSTEM - ARRAY, FIRST 20
101-0000-42403
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PV SYSTEM - ARRAY, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY AMOUNT
PAID
PAID DATE
PV SYSTEM - MISC EQUIPMENT
101-0000-42403
0 $23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PV SYSTEM - MISC EQUIPMENT PC
101-0000-42600
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $95.32 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$90.57
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
• • ••
Description: 9.OkW PV SYSTEM - (36) 25OW PAN ELS+OPTI M IZERS/(2) INVERTERS
Type: SOLAR Subtype: Status: APPROVED
Parcel No: 623510007 Site Address: 77914 GREY WOLF TR LA QUINTA,CA 92253
Subdivision: TR 29436 Block: Lot: 90
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Valuation: $45,000.00 Occupancy Type: Construction Type:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Applied: 6/30/2014 PJU
Approved: 8/19/2014 AOR
Issued:
Finaled:
Expired:
I Details: 9.OkW SOLAR ARRAY- (36) 25OW HYUNDAI PANELS W/P300 SOLAREDGE OPTIMIZERS, (2) SOLAREDGE SE380OA-US-U INVERTERS
AND (1) 100A SUBPANELS [648SF] 2013 CALIFORNIA ELECTRICAL CODE.
1 Applied to Approved
FINANCIAL INFORMATION
Printed: Friday, August 22, 2014 10:35:48 AM 1 of 3 or',R
SYSTEMS
EMAIL
NAMETYPE
NAME
ADDRESS3
CONTACTS
CITY
STATE ZIP
PHONE
FAX
APPLICANT
HELIOPOWER INC
25747 JEFFERSON
AVENUE
MURRIETA
CA
92562
(
CONTRACTOR
HELIOPOWER INC
25747 JEFFERSON
AVENUE
MURRIETA
CA
` 92562
1 (
OWNER
BRUCE IWAMOTO
I
(
FINANCIAL INFORMATION
Printed: Friday, August 22, 2014 10:35:48 AM 1 of 3 or',R
SYSTEMS
Printed: Friday, August 22, 2014 10:35:48 AM 2 of 3 !f srsren S
NOTES
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT#
CHECK #
METHOD PAID BY
BY
BSAS SB1473 FEE
1 101-0000-20306
0
$2.00
$0.00
TEMP USE OF PERM PWR
Total Paid forBUILDING STANDARDS ADMINISTRATION $2.00 $0.00
BSA:
PV SYSTEM - ARRAY,
101-0000-42403
0
$23.83
$0.00
FI RST 20
PV SYSTEM - ARRAY,
101-0000-42600
0
I $23.83
$0.00
FIRST 20 PC
PV SYSTEM - MISC
101-0000-42403
0
$23.83
$0.00
EQUIPMENT
PV SYSTEM - MISC
101-0000-42600
0
$23.83
$0.00
EQUIPMENT PC
Total Paid for ELECTRICAL: $95.32 $0.00
PERMIT ISSUANCE 101-0000-42404
1 0
$90.57 $0.00
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
TOTALS:00
Printed: Friday, August 22, 2014 10:35:48 AM 2 of 3 !f srsren S
NOTES
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
DATE
INSPECTIONS
COMPLETED
DATE
RESULT
REMARKS
SOLAR FINAL"
TEMP USE OF PERM PWR
ROUGH ELEC
Printed: Friday, August 22, 2014 10:35:48 AM 2 of 3 !f srsren S
Printed: Friday, August 22, 2014 10:35:48 AM 3 of 3 YSTEMS
ATTACHMENTS
Attachment Type
CREATED I OWNER
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
DOC
8/18/2014 AJ ORTEGA
BSOL2014-0002 corr
response.pdf
BSOL2014-0002 Corr
response.pdf
0
DOC
8/18/2014
AJ ORTEGA
Revl (Full Set)
BSOL2014-0002 Revl
fullset.pdf
0
Printed: Friday, August 22, 2014 10:35:48 AM 3 of 3 YSTEMS
Bin #
Permit # o% d l �-{
p�
Project Address: _ cf I .
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
--1 `e W O • Owner's Name:f3ruceQ
A. P. Number:
Address: GireqyVb I ('.
Legal Description:
City, ST, Zip: lJ } q22 5'3
Contractor:ell
Telephone: , '
Address:
J f
Project Description: P f +i
� � l a r- s4PY
yy.AA
City, ST, Zip: it e Ct7J
C A 12 -:SV Z
9Z 0—T Y1 D U 1(1
Telephone: l _ _ 7 �S'':'=f
u
�jiD a Yl St I's ?SD
State Lic. # : )
City Lic. #;
• ❑ �� W y�,
Arch., Engr., Designer:
Address:
1
City, ST, Zip:
Telephone:
w�
Construction Type: Occupancy:
type circle one New Add'n Alter Repair Demo
State Lic. It:Project
Name of Contact Person: 1V 1CAL 'E�Ci n dk ps po
Sq. Ft.: # Stories:
111 Inits:
Telephone #,of Contact Person: '
Estimated Value of Project: (jC c�
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Recd
TRACKING — PERMIT FEES
Plan Sets
Plan Check submitted
( )Item
Amount
Structural Calcs.
Reviewed, ready for corrections +��
r� flan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
echanical
Grading plan
2"" Review, ready for correctio is e`s
Electrical
Subeontactor List
Called Contact Person t Y
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
0