02090094 (2) OF
CI BUf DING DP DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
21695 REGNART RD NOR CAL SOLAR POWER 020900SUB D8q94
TE
M"MOHM 2929 EDISON AVE . #8 APPLICATION 02090094
PHONE: SANITARY NO. CONTROL NO.
(866) 615-0615
O OARCHRECT/ENGINEGR: a BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
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CL:l O L.:I L:.j
N i LICENSED CONTRACTOR'S DECLARATION Job Description
oi_o rtbya Natlamlicens�`rprtvirmmrmrenaplerpammmemmg SOLAR ELECTRIACAL SYSTEM
F:t--w NSc lion t000l of Division 3m.eB es and Professions Codc.ane my licrnss
E J I f I
z m Q Li Class a�ck-1 Lic,p��' t- 20
O y U D e lg1 -I .l'f _ t for
tw-a LLO In Cj
1 un ARCHITECT' ARATION
g dcrsmnd my plans shall to used as public rerord.a
E ani
i i cLicensed Professional
as
OWNER BUILDER DECLARATION
1.�T n 1 hereby of that I am exempt from the Contractor's License Law fa the
C?a following reason.(Section 7I31.5.Business and Pr°fcssams Cldo Any city or county $18000
E is which requires o permit to construct.alter,improve,demolish,or repair any swaure
t�3 _prior to its issuvnce,also rtquires theapplicant for such permit t°file asigrcdstatement ----
d ad Ink is Jimmied p°auam to di prom:ions of the Contacols License law(Chapter 9 ,� _ .r35 9,�. O Y IY',4GY�7;Qa•' 4 a — e'g;v Valuation
fcoopoeocitiaivithSecdon,]Wo)of Division 3 or the Bu;in=ss and Potassiums Carel {, )l1 L`.:.a, ♦'. .-] a3l!'e. �rS .L
or Ihai
He it Nenipe Ihimfrom and the basis for the mdeal eiemplion.Any violation
-of Section 703I;5 by any applicant fore pem,il'ti the applicant m a civil peadry.
Iofnw nmrethan five hundred dollars($500). 304 APNINDC ff ELECTRICL""111\0 Occupancy Type
OLarowner°fthepr°pertcompensation. 501 - FINAL ELECTRIC L ENERGY
will dothe'work,'medthe swcwre'is not'intended or offeree for side(Sec.70UI.
(Business ana'Piofessions Cede:The Contractor'a License law docs not apply to an 505 - FINAL EL ' jactions „'t'R•”
owner of srxi Who Wilds or ine oves thereon,ami who does such work himself
or through his own employees,provided that such improvelsmma arc not intended or
tcomplelion,the ownerWilder will have line Win of Proving mat W did not Wild or
improve for pumou of sale.).
.cogasowner oche popenynm Brimirvelyd Proeing withodi:) do C.t °rsm t��}�a.�.� tip :;iI 1.:C',•,1. 1 • ., .
License
the project(Sec. to a BmiMss and property
who
ills or The improves
the mr'a `r a 0 WJ� tl"t1 'J: . ELCCI _.. :. x' :
-- License law dues not apply
o:lo an owner with
popeny who W lids m improves l on the u .,
fors°ch.pojeclx,wiNacomracmrlO license).pursluncm me
- 'cors License Llw.c . (`4.'•I:: \«'.•Y f) h ...__._._
_ 9e e�Jx/(�—p}c" Sec: �_ 6rOB&PCfaNis reason OCTT /,r 1 260tht!:z'
WORKERS COM Dim / Z ..
ION DECLARATION BUILDING
'- I hereby affirm under penalty of perjury one of the following declarations:
_�� _ ❑ 1 Wive;ad'will maiamm a Cenificale of'Conunt m sell insum for Worker's
Compensation:as,provided for-by Section 3)00 of the Labor Code, for the
performance of the work for which this pooh is issued.
°1 have and will''mahmaiu Worker's Cmmpcn.ali°n Insumnce,as required by Section
37W of the Labor Code;for the prFfortnocgof the work for which his perrmt ix
iso d My Workers Compensation 1 uransm caiTier end Policy numilve
*:
b CERTIFI(;ATION,OFEKEMMONFRQMWORKERS - '- 1� '� Y •1t Sl' S <J= �.tri l�Y� `Y�/y.3 s(D-11:
COMPENSATION INSURANCE
(Th s'remum need nm W completed if the ,rmii is for one hundred dollars At \ t '" - M1'l- 1p" I f P11:0
Ship)W)or lerr.)
CR ion 1 Ice Pel f,h IN for wh h his pe n a s. d 1 > `.,,1. i.,','.{l til ° IJ J:
sh II 1 ply on ! I te •'S 1 ly bac nLe ubJ 11 the,W k
, 1 m 1y1d1h ^f !J 6
llTyi'ICETOO t I ICANr.7117.7mr makingmuCertificate of Exemption,you should
0 b'c h)ecl It Chard k t C pen t npro s ns Tice UWr Code,yogi mon
fomhw N romplywith ch prosi.vons Lir this permit shill be deemed revoked
Z
V� 'CONSIons LF.NDIN CY
4
o I hereby Nereisathat o t a Icding.'
'4 B S Y f ices parr nn ice _ .` '• }! ,. ' ,.
Gia+ kf hick ch th pc t . 'JlStt tlfi9rC C)
Un
z Lend ',Address,
V 0 1 ccmfY shat 1 have read this application end sum that the above infomtetiun is
fz'E. comae;:1 agree to comply with all city and county,ordinances and state laws relating
j�s'u to dingconswctinn:and hereby mabuim representatives nflhi,city to enter upon
ice Woa t nedp pcnyfrin,,w Wm°u .. .
IW lag m e d mnlfy and keep hat I.i th City';f C penin..,ain't
L (A li b'I t j dgmems c 1. d expxmvx which Y any Y c dins,said
V .zi Cly c req Ice ung i f ih s p=ant
AeeC1�dJT JD/r,I US�A�Nly WILL COMPLY
pWITH,\L N POINT7z
Issued by; Date
S ;RCE ,I,M lr.f/•\.J' ."r:. f... "1 G' ^ 6 2
_ Ssgnawrc of Applicaomuctoi "'"' I. "".i;,Doe,_ Re-IOOfS
HAlARDOUS MATERIALS DISCLOSURE oux material Type of Roof.
1, WIIIbeu li til ' Tore Wildin8 occupant rn handleh :Lid ..
'as do fined bN,lhe Cupen M m ipei Cldc Ch p¢rY 12 and N Health and Safety
YP y 4•.i. •'T(I, 5� ';a t`)
Y
Se
255T_( \ , t i,♦ 1 JIS ..
�e'OY' °.,_•_',,,... _ All.roofs.shall.be.inspected.prior[oany..roofing.material.being.installed.....-_.. ....._,.
Will m ppJ t r m enl buildg n tuse eq p 1 e ere hen If a roof is installed without first obtaining an inspection;I'agre'e-to remove
it h. redo a, morm,as defined by the Ba,Am.Air Quality Mnage nt
all new materials for inspection.,Applicant,understands and will comply with
all non-point source regulations:.•
.a, ,,1 have,read the hazardous maternal;mquirtmem,under CWplar 6.95 of me
if the buildingalth&Safety C d Sections 25505.25533 and d errand that ._. _...__ .. ...
H .. . .
does of count have ata f that,s myrepon'bl'ly t nm fy the __ _. .. _._-.. .
IXc V mcYf th rpmgn�h¢h ml_1 be met p r to ref atebf - -
wr) Q'/ /b D _ _Signature of Applicant Dale
i- Y - All roof coverings to be Class"B"or better
1;
Owale— rc'a Dam .
-._ .., ..-�,. . _. ._. OFFICE... ....