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Permit No. 2011-24996 • City of Chino Hills BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT 14000 City Center Dc,Chino Hills,DA91709 xs C + - Counter Phone (909)364-2780 Buildin Permit ^� g 24-Hour Inspection Line (909)364-2790 ��ppp�� (NOTE You must call before 3p m,fora next business day inspection) ! V Vl City Hall Main Number (909)3642600 J�` 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. INSTALL ROOF-MOUNTED PHOTOVOLTAIC SYSTEM. 2011-24996 BUILDING ADDRESS I APT.f UNIT NO. ISSUED DATE/ ISSUED BY 2128 OAK CANYON LN 17/8/2011 J Whiteman,Rosemary APN 103105104ITRACT TR1CT MA I L T I FLOORS/UNITS I PROJECT PERMITS I P.TYPE CENCUS CODES IVCONST.TYPE IZONING TYPE IOC OCCUPANCY TYPE IVALUATION $30,000.00 I TOTAL SOFT OOO I BLDG.SOFT 434_Res Add/Alter Contractor. AMERICAN SOLAR DIRECT INC-AMERICAN SOLAR DIRECT INC Fees Address: 2400 BROADWAY SUITE 240 SANTA MONICA CA 90404 Fee Group/ Fee Description Fee Amount Payments Ph- (424)214-6700 Email. rschneider@asdsolaccom Transaction Type Lie.fnfomlation941069 Exp.Date'12/31/2011 Photovoltaic System $677.08 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing B001 Permit Issuance Fee $53.00 53.00 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 I am acting with the knowledge of and on behalf of the owner of the 8003 Residential Plan Check Fee $231.08 231.08 property. `�, �j / 'l/� (J n �.� ��/7 c —� B39-853 Residential Structural Fee $355 50 355.50 CD tae/7-O-I l //Cooniracmr�--(L�W/iyl�W`-'!�- f U /� 8103 Conduits/Conductors $3550 35.50 \ OWNER-BUILDER DECLARATION (� $81473 $2.00 2-00 I hereby affirm under penalty of penury that I am exempt from the Contractors Licence Law for the TOTAL FEES $677.08 following reason,(Sec,70315,Business and Profesional Code. Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,pnor to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of AMOUNT PAID $677.08 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 call penalty of not more BALANCE DUE $0.00 that five hundred dollars($500.00) -_ I,as owner of the propterty,or my employees with wages as their sole compensation,will do the s__iv,,,k--- = I work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: _c=="T' The Contractors License Law does not apply to an owner of property who builds or improves thereon,and _ _ who does such work himself or herself or through his or her own employees,provided that such - p p^@' (�F improvements are not intended or offered for sale, if however,the building or improvement is sold within 1'� p^4°A �( �${`t? 3f4b 1`� } one year of completion,the owner-builder will have the burden of proving that he she did not build or it q^;^C P j'/"� � 6Ck L�COY r� improve for the purpose of sale) V, E-=.aiev I,as owner of the roei property,dy,am exclusivelyssions contracting with for s contractors to construct the project(Sec.7044,Business and Professions Code: The Contractors 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). r- ita ,_,;`- jam exempt under article 3 of the Business and Professions Code. Date: Owner WORKERS 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 forworkers'compensation,as I certify 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 forwhich this permit is with all city and county ordinances and state laws relating to building construction,and hereby authorize ( isssued. Krepresentatives of this city to enter upon the above-mentioned proptery for inspection purposes. 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 /) A_44.._ E n/ e/1 ` —_��_Q_ // insurance earner and policynumber are: gy�pp,�. is �(l'_SIGL �--h K--`-fit-- \g ( l Ce tri }Os�� /49IS FOE Policy APPLICANT SIGNATllftE O DATE i x �—:(D RLD E8 J Appli ^—ASH4 GELHARDT _ - I certify that in the performance of the work forwhich 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 Address' 217NSUNSETAVE CRY OF INDUSTRY CA 91].14 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. Ph: 310-710-5351 Email' m@ch.org --___-_->,, .'YI� /// tic.Information Exp.Date: (Appiiwn �5a=_ sem..._...... '� I certify that the user of thrs facility shall comply with sections 25506,25533 and 25534 of the Health and ion Safety Code,which regulate the storage,handling and use of hazardous materials WARNING. Failure to secure workers compensation coverage is unlawful,and shall subject an employer tof mmol s and one hundredthousandof t e a ($100,000),00e iettldnd toat the east ee compensation,tlama9es as provided for m section 3706 of the Labor Code,interest,antl attorney's fees