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GONTRACTORINFORMATI01
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
REG ID POWER
P°`""No'06070132
22405 BALUSTROL CT
OWNER'S NAME:
PERNITI SUE DATE
KEELER
1624 DELL AVE
06
.FRANCIS
E
SANITARY NO, CONTROL NO,
(408)927-0811
ARCHDECTYENGINEEA:
BUILDING PERMIT INFO
BLDG EIF1T PLUMB MECH
0
LICENSED CONTRACTORS DECLARATION
lob Description
1 bcrtby .farm tbal 1 w ncenmcl watt provisions ar Chap.v 9 pmmmexWg
wWSatim]Of10)afD{vido.7ar NC Busn=a and ProfrJsbos Codc.W rB¢nc1,
M con I. mW afro
INSTALLATION OF A SOLAR ELECTRIC (PV) ON A
RESIDENTIAL ROOF
o �7S7pT—�nr
-I riECTS =tMIN
1 onoi and my Plsaa shall be coed u public rotors
Ixmnsed Pwfa�omi
OWNER -BUILDER DECLARATION
I bemby mRrm Wm I uamp from the Commaetara Lkenae lar par the
]R71.3, B mil Pm(emoni Code. Roy mumy
nt aims. t.
mity a
rocaYNucl Y'c.m ate itdrany mn.:turt
rhir tonna t alloy.
whix:h
imryWmapmmlt
for h&mnlIah
P.It,
p.lorwiU iuuarrm. also tryWmn lhcapplkun f«wchpmoltmfi4 snp,W nsrrticni
Cmtmacwr'a Li.s Lar(Cbaper9
Sq. Ft. Fl oor Area
Valu 16000
bculken.Cid purvuvlmdc pmvi,iaatofdte
(coanmexiaj wNSalm 7000)af DiWbn7ar Ne Rudvusand Rofrulaa Codd«
tlut he U aaampt Ibo anmo mat bo b.a. for Ibe .liqui e,®pdon, Any v moon W
APIA Nprtlbler
U anC
Occupancy
Sadm 7031A by myapplkau fors pumit mbJena the .ppli m. Cib Pwlty of
mm moo than nw beodmd dolls, (5500}
3 Sbb �V 3i UU 11 o o
❑I.navty of Ne Praperryaavry aaPialvia rlW map utbebm4eompmudm,
Required Inspections
9 P
.mmf,,6,ua,noC'.ti lIit,eaoLa 4ant* Y a'•B of
mw Pmremau Cade: ml co.ibao .
whe lir dm, cot �y m an aw,aer ar
r! ba
W=a; mwnmado bimffard
(Z`XJ
owno/rhohuild.ari mclooraoaih
ora empMYcbuiP5ntbrudw mehImPrmemaW uCi vatW¢rW9 maQertd fa U,
sash fico
ma
hvwercr, We boildiag or impmtenca V mid riWiv om year N mmp4im, da wm.
builder wR harc de btvdm of pmviag Wal "c Std .m ddM or 4opmw for pmpoY a!
/
( / /�
a4.}
/
❑ 1. a woo of Ne P•oPatr• .m eaeluively aminalo{ C -n rnn n
maov Ne pole¢(Sec Bus'vaeaand Praletti d ,) Th. .
olds-:1ThC tmno,L4
ymu awnrroftr=.0 rho bands«cop. tho Werma.
<ma fAr do to an.
La
.
for mit polatts rbh v covtrana(.)14sved pwmu«m Ibe Caamcrar.
rin momma or mit
❑Taut ea,mpvnda See ,BAPC for dtis mum
0. D.me
WORKERS COMPENSATION DECLARATION
I hertby aQ coder Pmolty or pe0my scar Ne foBawbn trcUrmiont
baKarat Will winaiaa CenaRom ar Cmuentbself Bart f«w.t 'Compeo-
adon• u prmided fa by Section 7700 of the lobar Code, for the pafmmr. U do
wart for which this p emit is ward.
0 1 Itaw mail mpI muouBt Water. CampmsWm lamrana, u mqubW by Scrum
'
3' or the Labor Colo. for the lfform arco of We wart far thv permit IS iaaa .
My W , an e.uda ¢ or nil Policy _ "
crkn,ft4y No_ V
GTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clbla calm a=d cot bccomplo" U Ibe push 41=ane buntrN dollen ($10(f)
or kat.)
1 emir, Nu la We Pcrfornan,a: of the r for w1b41b WI. permit N iuud. I .b.n n«
vplay my actsm In my mucor to u to become abject to We Walxn'Ctimpa tloo
`
Loan or Czhform m Dmc
Appl am
NOTICE TO APPLICANT: If. after mating this CevlRa¢ N Eaemptim, Iou.hmM
D=ome sob}em m Ibc Wort,&. Crmpenatim pr ^ n a a( We Labor Code. yea Ism
Z forNritb mmpy r'uh socla provi or Nis permit "I be da,ncd ma
O
mNrrxurnoN LENDING AGFslcv
.
1 hereby far the Palomar,¢ W
hpuo
4va ccd
> the ofa vbich to .TsNatrt IS(Sm. 3097,Civ. C1
Nude
z
u nditeadn..as
lcMera A
p 1 comfy that 1 hare road this applkmim mat mato that the .bo.e wormed. is
caracL 1 yrs in comply with 01 Wry mat cowry coli"•^^• W ,tate lar. rotating In
V bWMing cammnctlon,Whembyautkdn mpaenuliss of Nit city oro oow upon dm
ahv.a.memiacd pmpcny for Wpcctim pta '
(We) agroc to are, indenmiry and It cp hamka the City of coomoo .gains
lnbililka.Jtadg .Tessa and up which M In my ray.crrve yilau aid City
of too gof
Z in iL
APPLICANTINTLUNDERSTANDS AND WILL COMPLY WITH All NOWPOINT
Issued by: Date
SOURCE RE -7/D�
(to
Re -roofs
Type of Roof
g%
Sigbuurt of Appliam/Caouxt« Due
IIAZVtD0U5 MATERIALS DISCLOSURE
Will tuu� EWplShandk ho,NonsmamriY
CKapWtmrwc«
u dmd bylboCapa +dma Cottle. 9.11 =rat doe HeW arW S.Icry
Cao. sealw 15512407
All roofs shall be inspected prior to any roofing material being installed.
❑ ver
If a roof is installed without first obtaining an inspection, I agree to remove
Win t>r applivm or root with, aavlam ase'. m" or dedw wbkh
haumdmm air amtamimmts as dclbmd by Ne Bay Amu Air Quality Maoycmem
all new materials for inspection.
Di Wn7
v
lhmmad Ne N.Sec smua5.2553fv CMpu695Nthe Cmifng
M, .lu
niaFMIW&Saftty Cah,S=dw ]35115.15513 nil 15531.11ndcartvat dtrifde bdMinp
Jaacot cwrer,lY N.a .mal Item It 6 my rost,oality n aaifY the ou�4mv al Ne
mgnb a erns act muwa co ,Caufaxaroc pmmy.
Signature of Applicant Date
%O
All roof coverings to be Class "B" or better
owntt a auVtmi><d a a Dam