07120257 CITY OF CUPERTINO
BUILDING DIVISION PERMITCOC'TnRIN' '
BUIIDING ADDRESS: PERMIT NO.
10265 ANTHONY PL AKEENA SOLAR, INC 07120257
W NER'S NAME: PERMIT ISSUE DATE
HUGH JACKSON 16005 LOS GATOS BLVD 01/28/2008
HONE: SANITARY NO, CONTROL NO.
(408) 867-0558
ARCHMIC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
300 LICENSED CONTRACTOR'SDEOLARATION ." Job Description
'�+ 1 hereby affirm mal.i am limned under provhions of Chapter Y(commencing Job p
with Section 7000)ofDiA.I..3.f Me Business rohouse.CMa,aMmyli.m.ts INST 33 ROOF MOUNTD PV SOLAR MODULES
R 1 in full forte aM orfec
Z Lhense Class Lm.
Dam Contractor c2 1116 jAg
ARCHITECTS DECLARATION
oI uMenand my plana ahall W used as public recmrls
u
hh8 Licensed Panfaroh nal -
y OWNER-BUILDER DECLARATION
Coro ON
COO I hereby a1Bm cont 11. aempt Business an Ne Conmdors :My c taw for the
4 p o following maw n.(Section 71p 1.5, alor. and m, on demolish.or My city or county
e$�i which mqulou n pmmio se enrhWct pWr.improve, ermitLare a sig any skean
u_� Roof to its Issuance,p also mqo Me pro inion nt offer soca perm's 1.1c ns,Law Catomem
p'3ss� that be is licensed puruunuod)of Division
of the eBuedmiUmnsclaon,Code)at
Sq.Ft.Floor Area $ Valuation
YF�
(commencingheisecuept Secfiromon ndTheivhfor of alleged
exa pilon.essionsCMe)of 36000
.. mato r 31.5 b dem(rom and the aper for bj alleged ervmant to Any violation of
Secam Man
five
ury red d.il fora permit objects the applicant a evil penalty of 3 4 212 0 71 !��Number Occupancy not mom daon few hundred dalhn($5110). P y Type
Q 1,asowner of Ne property,army employees with wages u meirsoleeompenudon,
will do the work and t eaunctum is notimmnded aroQered formic(Sec.1014,Business
and Pofepelan Cede:The Contractors License Law deet at apply to m we,of Required Inspections
proper,.1m Wild,arimpows therma.and whoduessucb work himealforthrough his
awamnPloyw,provided that such Improvements tie notimmnded aroQemd for We.IL
howewr,me building or Impmvemmt Is sold within am year of completion,me owner.
builder will have the auken of moving Nat Its did not hold or improve for purpose of
as1eI.
Q I.u awns of the property.am aselusively mntraeting with 1)mmed mnweton to
contract me project(See.7044,Business and Profession Cade:)The Contractor's Li-
cense taw does not apply to an owner of property who Wilds or bro mves daemon,and
who mannish for such projects with a conuacnor(U licensed pursuant to the Comactars
License Law.
❑I um aempt under See ,B&P C for this mason
mer
Data
WORKER'S COMPENSATION DECLARATION
1 hereby afro under penalty of perjury am of the following declandone:
Q l haw and will maintain a CeniacamofConsent to nelf-imtm far Warkers Campen-
saion,a providM for by Section 37110 of the labor Code.for the performance of Me
work(or which this pemit is issued.
' haw and will Maintain Wmmes Compensation hatranm,a required by section
31%or me labor Code,for the performance ofine work forwhich this permit is hrumL '
My Workers Compensation uruururm seder aM Policy toaster
r
Caller, Policy No.;
6 ER FWPf10NFROM WORKERS'- ~
COMPENSATION INSURANCE
(@r section need not las comple cd!film permit is fcroto hundred dollen($lay)
or leu)
1 modify man in the performance of me work for which this permit is Wood,I shall cot
employ any person in any mannerm a to become subject to me WorkerCompensation
Laws of calif onia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CcNHam of Exemption,you should
became subjm to me Workers Computation provisions of the labs Cade,you must
.,O forthwith comply with such provinces m this Permit shall be dmmM mvaked.
,'Z.a 7)
CONSTRUCTION LENDING AGENCY
[-r I hereby aEm door mem r a construction lending agency for the perfumanm of
LYi the work for which soh permit Is issued(Sm.3097,Civ.C.)
WLenders Name
Z)Z Lenders Addrut
U Q 1 mnify mat I haw mad this applicuion and shin thal the stow information is
4.! coon.I agree he comply with all city and county ordinances and mase laws retailing to
8 xS.'J Wilding construction,and hereby mtharice representatives of this city to enter open me
atow-meManed property for inspection purposes
y (We)agree to save,indemnify and keep hammpe duce City of Cupertino against
t„rr3 liebilidu,judgmenh,cnts and expenses which may in anyway mcme againsnmid City
)7 in consequence of the grating of this pemlL
r� APPLICANT UND DS AND WILL COMPLY WITH ALL NON-POINT Issued by:34�� az Date Lia
Re-roofs
Signa
HAZARDOUS
AZApplicaRDOO Rmem
HAZAUS MATERIALS DISCLOSURE Type of Roof
Will thecCalamm(umm Wal Coe.Chapter 9,12,
had eHallousmamdal
as dented by me Cupertino Municipal Code.Chaprcr 9.12,and de Health and Safety
de.Season 255324). All roofs shall be inspected prior to any roofing material being installed,
Q Yu hN.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
coin huardoes air contaminants as dcfim l by the Bay Arta Air Quality Management all new materials for inspection.
Diwicr7
Oyu �]No
I have mad me hams crisis crisis requirements under Chapter 6.95 of the Califm-
nieHealth&Safety Code,Section 25505,25533 and 25534.1 undersand that irate Wilding
does not currently haw•mnenl that u r m maponsihll"to mofy de hcupam of the
ma fl CaAOesmof Ocmpan Signature of Applicant Date
Owmr or awhorimd agent Dam g
All roof coverings to be Class"B"or better
'