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Permit No. 2012-26472 , . . City of Chino Hills BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT r• 14000 City Center Dr.,Chino Hills,CA91709 SF4 4.-Y-tri r-krce ffit _ .• Counter Phone (909)364-2780 Building Permit . 24-Hour Inspection Line (909)364-2790 (NOTE You must call before 3p.Mfora next business day inspection) City Hall Main Number (909)364-2600 Oki —9. NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. PERMIT No. ROOF-MOUNTED PHOTOVOLTAIC 2012-26472 BUILDING ADDRESS I APT./UNIT NO. 1ISSUED DATE ISSUED BY 16500 CELADON CT 10/1712012 Whiteman,Rosemary APN 1TRACT MARC !LOT 1FLOORS/UNITS 1PROJECT PERMITS P.TYPE 101773206 '1R13507-5 21 I CENCI'S CODES 1CONST.TYPE 1ZONING TYPE IOCCUPANCY TYPE 1VALUATION I TOTAL SOFT IRMO.SOFT 434 Res Add/Alter VB PD R-3 530,000.00 0.00 Current Owners: Fees Name:ADONIS CUTCHLOW Fee Group' Fee Description Fee Amount Payments Address. 16500 CELADON CT CHINO HILLS CA 91709 Transaction Type Ph: 909-597-7337 Photovoltaic System $678.58 Email: m©ch org Contractor SOLAR SERVICE CENTER-SOLAR SERVICE CENTER B001 Permit Issuance Fee $54.00 54.00 Address. 72227 ADELAID ST THOUSAND PALMS CA 92276 BOOS Residential Plan Check Fee $231.08 231.08 Ph, 761-641-3858 Entail: LILIANA@SOLARSERVICECENTE B39-1153 Residential Structural Fee $36550 355.50 R.COM . Lim information961939 ENT.Date:6/30/2013 B103 Conduits/Conductors $3600 35.00 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION 5131473 $2.00 2.00 I hereby affirm under penalty of penury that I am licensed under provisions of Chapter 9(commencing with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. In secunng this permit lam acting with the knowledge of and on behalf of the owner of the TOTAL FEES $678.58 property. 1 II,- AMOU D W78.58 (...Date: (?)". ore_t aetor: C/ 61-1-4174.0 4 SR.../) X....BALANCE DUE $0.01/ OWNER-BUILDER DECLARATION C__} I hereby affirm under penalty of perjury that lam exempt from the Contractor's Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant fir such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors 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 Sec.7031.5 by any applicant for a permit subjects the applicant to a conl penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,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 License Law does not apply loan owner of property who builds or improves thereon,and who does such work himself or herself or through his or her can employees,provided that such 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 she did not build or improve for the purpose of sale). las owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). I am exempt under article 3 of the Business and professions Code, Date: Permittee. Print Full Name: 1 WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations- I have and will maintains certificate of consent to self-insure for workers'compensation,as I cerhW that I have read this application and state that the above information is correct. I agree to Comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building constriction,and hereby auffionze issued representatives of this City to enter upon the above-mentioned proptery for inspection purposes. KI 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. /33 1 .1-MI f(-41-1 S) DATrEM /CI 7-ra- Gamer Policy • •LICANT SIGNATUR 41: AppftcaF=effErrEvELyN g - . ‘).-- ----____ I cern 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 worker's compensation laws of California,and Address: 72227 ADELAID ST THOUSAND PALMS C 9 76 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. PIT 760-641-3858 Email: mQch.org — Lb .Information Exp.Date: Date (Applican.. - la", I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and Safety Code,which regulate the storage,handling and use of hazardous materials T••'WING: Failure to secure work-,s compensation coverage is 411,46 I,and shall subject an employer to criminal penalties and civil fines up to one hundred thousa •dollars($100,000),in addition , to the cost of compensation,damages as proceed for in section 3706 of the Labor Code,interest,and . attomey's fees.