05120128 CITY OF CUPERTINO
'['OR INFO TION'-"
BUILDING DIVISION PERMIT COXTAXC
BUILDING ADDRESS: AKEENA SOLAR PERMITNO.05120128
20847 FARGO DR
ER'S NAME: PERMIT ISSUE DATE
CHADE-MEUG TAU 605 UNIVERSITY AVE 02/03/2006
NE: SANITARY NO. CONTROL NO.
(408) 867-0558
ARCHIIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION JobDescripton [t3 (y I�
1 botchy of on Net I am licensed under provisions or Chapter 9(commencing r,,,,{,,�Lk tttpppp1111//{y�T�3 PJ 1!f��'g
with Section TOM)ofDWwhm Sof the Beat.end ProfeSalons Codd,and my he..is ( U IIS' tl�i�®
n m fan force and a ec Lk.1�y/��e 15 SOLAR PANELS U k 'I ifjy�
?
ARCHITECTS DECLARATIONI)„^.t` Ze 1006
I understand my plans
ARCHITECTS
rke used u public
g c� Licensed Professional _
`0 OWNER-BUILDER DECLARATION But
t� i� („� r
I hereby effort that I em exempt from the ContructorS License law for the {y Iii f;��++AA lY
p O following moron.(Section 703 1.5,Business and P climsm.Cade:Any city m county V (the if L�
$Ixi which eaquiru a Permit a eonsuuet alter,Wprow,dcmoltsh.o repair my strvewm U V�v :1,9 0 0 0
prior to its Issuance,also requires the applicant fosuch permit to file a signed statement
g bT0A that W am
is licensed puat to Ne provismuof L
the Contractor's iense Law(Chapter 9 Sq.Ft.Floor Area Valuation
O$ (commencing with Secdon7DD0)of Division 3 our the Business and Professors,Professors,code)or
3 that he Is exanpt therefrom and the basis for the alleged exemption.Any notation of
Section 7031.5 by arty applicant for•permit Subjects the applicant a a civil penally of r Occupancy Type
not mare tom 0.hundred dollen($500).
❑1,u awor of thou property.m my mmploycu with mgu u thtr sok emnpemadon.
wiBdo Ouwwk,mdtheswctumanetinuMedmoReredfoula(S .70N.Budneu Required Inspections
and Profesdom Code:The Canmcmes Licence law clow,tet apply a m e owner of q P
property whobuild,orimprows thereon,and whoalmssuch work himselfor Waugh his
main coplayms,provided thatsuch Improwments am not Intended ooRmed for Wn.IL
however,the building or improrommt Is mid within ane year of completion,the awner
Wild.wild haw W burden of proving dot he did nm Mid or improv far parpom of
Sale.).
Q 1,as owner of the property am exclusively contracting with licensed contractus to
construct the Project(Sec.7044.Business ad Profusion,Code:)The Comesseter'S Li.
came law docs not apply m an owner of propenPwito Wilds at improves dhertan,W
who contacts for such projects with a contractor(s)licensed pursuant to the Camoselor's
License Law.
❑1 am tempt under Seo. .B As P C for this mann
Igr Data
WORKERS COMPENSATION DECLARATION
1 hereby Law under penalty of perjury cote of the following d.lanuoru: ,
1 ban and will maintain aC.Ofieste of Coment a self.Maure forWokeh Cooper- _
ration,as jumbled far by Section 3700 of site labor Cade,far the perarmmce of site
work for which this permit Is issued.
❑I law and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the wort for which this permit is issued.
My Work Ca pe ado I'man"eartier and Policy num''beerrrue:
Cenier. COM M Polity No.:�J60' 1i y4�
RPM TEOF EKFI.SPI70N FROM WORKERS
COMPENSATION INSURANCE
(Missectim need tet W completed UtW permit U forohm hundred dalan(SIM)
or len)
I cenify that In fee performance of the work for which this permit is Issued.l Shell net
employ any paten In any manor an as in became subject to the Worlwa Compenmdon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you Should
become subject to the Worker's Compensation pmvisions our the Lebo CMe,you most
.J O faMisi
with comply with such pmvem or this permit Shall W deemed avaked.
z ti
CONSTRUCTION LENDING AGENCY
[—h I hereby affirm that dam is a construction lending agency for the perfurmnce of
the work for which this permit i,issued(Sac.3097,Civ.C.)
I[7 Q Landers Name
}Z IaMers Addrw .
U0 T certify that 1 haw mad this application and sure that the thew information is
D. Conant.I agree to comply with all city and county ordinances and sate laws Telebras In
O Wilding construction,and hereby authorise repreunutiws of this city to enter upon the
W she-mentioned properly for inspection purposes.
(We)agree to Saw,indemnify and keep humkss the City of Cupertino against
OT Ilabilides,judgme na.emu and expenses which may in anyway accmc against mid City
C.1 APPLLIICCANf UNDERSTANDS AIn coequenof the ruling of thIND WILL COMPLY WITH ALL NON-POINT Issued by: Date '�3—C�j
SOURCE REGULATIONS.
Z/
Re-roofs
Sifu111:M Data
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the Cupertino
M
m far.Wilding aceupat Amor handsua
hNom material
M defined by thea CupeNne Municipal Code.Chapter 9.13.and the Heals and Safely
.Section 25533W? All roofs shall be inspected prior to any roofing material being installed.
[3 yes 19 No
Will the applicant our future Wilding occupant use equipment or Ill which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air commemants as defined by the Bay Am;Air Quality Management all new materials for inspection.
District?
❑Yes SNo
I have mad the livardem material,requirements under Chapter 6.95 or the calla.
nia HealthA,SafetyCode,Sedans 25505,25533 real 25534.1 Molmo nd that iflhe Wilding
does tet currently haw a anal that It is my responsibility In modify the occupant of the
onMeCmoniswhlchomMUSIetpriaraisrumceoracenificawo37V/S,_-,,
t]tupmry. Signature of Applicant Date
��w. y/3/06 All roof coverings to be Class"B” or better
Owner or authorized egenl Dam