04080006 CITY OF CUPERTINp ra -r'S�'@'s�.. at'" �" •<;`D5"- aa�
BUILDING DIVISION P>✓RMIT "ONTI2ACT;C)RINF,®RMAION '
BUILDING ADDRESS: PERMIT NO.
MC SOLAR ENGINEERING 04080006
11Q MR ANZA BLVD
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY _C6NtR0L NO,
?91 -1211
ARCHITECT/ENGINEER: BUILDING PERMrTINFO
BLDG ELECT PLUMB MECH
yup LICENSED CONTRACTOR'S DECLARATION lb Description
i F I hereby affirm Nm I am licensed unpp r prov�ipo os of Chapter 9(commencing
sZ tu with Seeaiun 7M))of Division 3ofthelsusi=stud Professions Code.and my liccomis
^aa infulAl farr5S(�9 and c tett. ply.µ
Z p o Gass ,(fY%.+ i _camrznor •7M �iF� REVISION--IN HOUSE USE ONLY
^ w ARCIi1TEC7 ATION NO NEW PERMIT ISSUED/ ORIG. #04030224
estI understand my plans shall be used as public rearims
JyU
30H
Licensed Pndcs'ional
OWNER-BUILDER DECLARATION
O
i S I s. affirm the 11. exempt from the GOntracroo' An,c Law for the •
p o which ire recon.(Section Aonstr Business and ve de io demolish,
Code:Any coy ar county V
K m which its r a c.1to mei. he applicant
alae improve,demolish,fi repair any structure
thiormiuiensed purarrarquithe thovisioso for Contractor's
karts Law(Chapter
< maThommi gwithSrstion70heofDivionsn of the
ndProflzw(Code)or Sq. FL Floor Area Valuation $0
mi-0 that he is xempt t erefro 7 and the, n 3
du the aged exempt on.Any
Code)or
n that he a exempt therefrom and Ne baso for be alleged exemption.Any violation of
OuNo,a than by hany undrddollarsfor a S50rmit subjects me applicanuoaCivil penalty Of APN Number - Occupancy Type
not mom than five hundred dollars(E500). � e
❑I,as owner of the property.or my employ cea with wages as their auto compensation, 31626093 . 00 .
will do the work,and fie smacaum is not intended or offered for sale(Sec.704141,Business
and Professions Code:The Cmmarmra License Law Ines not apply Ice an Owner of Required Inspections
property who builds Or improves thereon,and who doessucM1 wart himself or Borough his -
own employes,provided thalami improvementaare not imended confirmed for sale.If,
however,the building or improvement is sold within one year of complmion,the owner-
builder will have the burden of proving that he did not build Or improve for purpose of
sale.I.
1,as owner Of the property,am s.lusively summed,with licensed eonuxmnrs to
commuct The pmject(See 10414.Business and Professions Code)The Contractor's U
mote Law does not apply to an owner Or properly who builds or improves Ihe¢an.and
who contracts for such projects with a contrnmor(s)licensed pursuant o the Contractor's
Lice.law.
❑1 am exempt under Sce .B&P C for this mission
Dam
WORKER'S COMPENSATION DECLARATION -
I hereby aRtm under penalty of perjury one or the following declarations:
1 have and will mainarm a Certificate of Cement to elf-insure for Worker'sCompen-
sarion.az provided for by Section 3700 of the Tabor Code,for the performance,(the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of One labor Code.for the perrarmance of the work for which this permit is issued.
My Workers
Compensation Insurance carrier and Policy number am:
Policy No.: siG.:~%. C .
CERTIFICATE OF EXEMPTION FROM WOR
COMPENSATION INSURANCE
(ails moron recd not hecompleted tribes Permit is Por one hummed dollars/E10()
or less.)
I certify trial in the performance of Ne work for which mis Permit is issued.I shall not
employ any person in any mannerm Is in become supper to The Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate Of Exandumn,you should
become subject to the Workers Compensation provisions of the Labor Code.you must
z forthwith comply with such provisions or this permit shall le deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
f~K., I hereby affitm that there is a eonswetion lending agency for the Performance of
IX > the work fur which this perm it is issued(Sea.3097.Civ.C.)
n-) mLendcis Name
O. Landers Address
az
U O 1 eNfy that 1 have read this application and smu:that the above odmmatmn u
U.F COOCCL 1 agree To comply with all City and county ordinances and sure laws relating to
building consouction,and hereby authoris m
mpresenhvcs or Nis city to enter upon the
IUt] ahove-mentioned popery for inspection purposes. a
a (We)agree m save,indemnify and trop harmless the City of Cupertino again',
Vy liabilities.judgments.costs and expenses which may in any way accrue against said City
U z, in consequence of the granting mine permit.
F-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da - '\
SOURCEREGULATIONS. y/r
` -
L 4 Re-roofs
S azuigbf.Wlicahtlgcnvanm�'— am
/// HAZARDOUS MATERIALS DISCLOSURE Type of Roof \
Will the applicant or future building Occupant store or handle hararduus material
as defined by the Cupertino Municipal Code.Chapter 9.12,and Ne Heal@ and Safety
Cndc.Section 25532(a)7 All roofs shall be inspected prior to an roofing material beim
❑Yes (fin P P Y g g installed.
WII the applicanlor future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
tonal?
❑res
I have read the hanobous materials requirements under Chapmr 6.95 of the Califon
nia Health&Safcty Cndc,Sammar 2554)5.25533 and 255341.1 understand that ifde Wilding
does'noI nEly.have a¢ nt Nat o i'my ma,maihilit m notify de cupanT of Nc
req rc ants bich must boy met prior to comamcc of a Ccmr mOf Cato y.
�Zz1� SignaturcofApplicant Dale
Ower or a cert ilgena i—� t`�• All roof coverings to be Class "B" or better