08090010CITY OF CUPERTINO
PERMIT.,CONTnRA.CTORINFORMATION
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,
BUILDING DIVISION
s Vic_'
BUILDING ADDRESS:
PERMIT NO.
22265 CARTA BLANCA ST
AKEENA SOLAR, INC
08090010
:R'S NAME:
PERMr[ ISSUE DATE
LINDA & JEROME MARTINO
16005 LOS GATOS BLVD
09/19/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMITINFO
INSTL 16 RF MNTD SOLAR MODLS
BO
O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hemby M. that I sm B¢ued ander pmvisiom of Cbapmr 9 (comae of
with Section 7000) of Division 3 of the Business and Prafcuimts Code. and my license is
in full tante and ertett LOb ROS 773
.
Lianslyun Lic.g
/�✓'II
Date /, Conuactar
ARCHDECLARATION
k led
1 undcrsmnJ my Pons shall ll ho d u public reroN.
Licensed Professional
OWNER -BUILDER DECLARATION
1 thereby M. Nat 1 am exempt from It. Convenor's License Law for Ne
following Motor. (Section 701.5, Business and Professions Code: Any city or county
which recut. • permit m emmmm alter, imprmo, demolish. Or repair any smnurc
! prior to its issuance, also reports the applicant forsuch Permit to file a signed susemcm
that he is licensed thc of the Contractor's Ucense Law (chapter 9
Sq. Ft. Floor Area Valuation
pursusnuo provisimu
(commencing with Section ]BBB) of Division 3 of the Sudr..• and professions Code) or
Nat he 4 exempt therefrom and the bu4 for the alleged exemption. Any violation of
Section 7031.5 by try applicant for. permit subjects the eppliem, m a civil Penalty of
APN Number
Occupancy Type
not mom than five hundred dollen ("00).
❑ I, u ownerof the property. or my employees with mgea ss theb sole compensation,
and he Con isnot Intendedm awdo (o rale(Sec.]014,Bmims
oro Code 71he Convenor's Liame hem don not apply lf rt rouser
and dothework, Code:
Required Inspections
workhhnselfmthrough his
Property is
progenywhobuildsviireprovesch
imprandwhodocso,
Provided not intendedmoBernd We It.
awmver. Etiouns,the
prsocaentIssemenLLare
improvement 4 thefor
within one you of completion. theowner,
haweev. Ne ower,
tbuilding u
have that a of
builder will save the buten of paving Nat he did not build or improve for purpose of
aleJ.
❑ 1. as owner of the property, am exclusively contacting with licensed convacma to
common the Pa leer (Sas. 7014, Business and Profession, Code:) The Contractor's U.
cense law doer not apply m an ownm of property who huilds or impmvm Neeson. and
-'
who ce mUaera f n amlr Projects witha COnaanm(s) IIRM1Rd poex am w the C'ontractor's
'
License law.
exempt under See ,B&PC for this moon
I.
to Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury, can of the following dm4atiam:
Hom and will maintain. Certificate of Consent to nif-Mum fm Worices Compen.
sstion, as provided for by Section 3700 of the Labor Code, fm the performance of the
work for which this permit is issued.
❑ I have all will maintain Worker's Compensation Insurance, u required by Section
3700 of the labor Cade, for the per(omsna of the while for which this permit is issued.
'
My Worker�slCompensation Insurance are
career and Policy number a: _
Cartier. Tf Policy No.: -3N y $ i 3JS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTisseNoe recd Trot ho completctl Bthe perch is fame hunNeddollm (SIM)
Or ass.)
1 artily that in Ne performance of the work for which this Permit 4 issued, l Mail wt
employ arty person in any matuherm u to became subject to the Workeri Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT: If, after making this Ceninam of Exemption, you shouse
becmne subject m the Workers Compcmktion pmWtam of rite Ulatr Cade, you muss
forthwith comply with such Pmvhiom or Nis permit shall be deemed rtmkcd.
CONSIRUCnON LENDING AGENCY
1 hereby aim the there 4 a comtmctian lending agency for the performance of
the wea fur which Rds Permit 4 issued (Sec. 3097, Civ. Q
Undoes Name
Iander's Address
I coni fy that 1 have read this application and auto the the above infumtlun 4
coact I agree In comply with all city and county Mlicanaa and sum lava mladng in
building construction, and hcreby. ubod. repreantstiv a of Nis city m caro upon the
shove-montiormd property for inspection purpomi
(We) agree 1. sax, indemnify and keep harmless the City of Cup nmd .punt
liabilities, judgments. costa and expemn which may in anyway amnhe against to City
in consequence of the panting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Issued by: Date Le
y�
,' 9ll11,9,5
Re -roofs
Signature of ApplicsoMmit actor Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the appliout m lmore building aectinum store or handle haallo e, mamrad
Based by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety
Jc. SD y. 25532(.)?❑
Dy. ,!i(Na
All roofs shall be inspected prior to any roofing material being
g installed.
Will thea rant or future building oma nt she
PP B W mJManaement
If a roof is installed without first obtaining an inspection, I agree to remove
g
Area Air Qu
cDisitrict? m air canuminants u defined by tiro Bay Arca Air Quality Management
all new materials for inspection.
QYn fONo
T have mad the hvardousmamrialsrcquimmcnts under Chapmrb.95af the Califor-
ma Health &Safely Code. Striom 25505, 25533xodi 2534. T uakrstW tiro Jthe building
does not cummly have a tenant that It It my responsibility to notify the occupam or the
requirements which most In met prior m LyuyLS Of a Certificate Of Occupancy
g
Signature of Applicant Date
All roof coverings to be Class" ' or better
ownm aranmrrived apse Dam -