08080023 '747
CITY OF CUPERTINO " *inti. -,. 7'
BUILDING DIVISION PERMIT CTORINFORMATIOV
BUILDING ADDRESS: PERMIT NO.
10.181 FINCH AVE AKEENA SOLAR, INC 08080023
OWNER'S NAME: PERMIT ISSUEDATE
"ETHEL LUTHERAN CHURCH 16005 LOS GATOS BLVD 08/19/2008
NE: SANITARY NO. CONTROL NO.
(408) 867-0558
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
B ee p LICENSED CONTRACTOR'S DECLARATION O O O O
im 1 never,affirm Nat 1 sum licensed under provisions of Chapter 9(commencing Job Description
^U vith Section 70M)of Owiskut 3.1'Me Business and Proficautiones Code,and cry license is COMMERCIAL—INSTALL 150 ROOF MOUNTED SOLAR MODULES
m full folm and Uf L
;'q? Ldeo mens Ue.t 'tta $a5��} IF CABLING FOR THE SOLAR PANELS ARE INSTALLED
-f O DamCmi mese R M 1
' ARCHnFf_101 DECLARATION ALONG THE EXTERIOR OF THE BUILDING, THE CABLING
s
V 1 understand my plans shall Po uncd u public records
kC: Licensed Pnsfcyianel
j3 OWNER- RDECLARATION
M 1 hereby affirm Nexamptal I am ezempl from Ne Contractors Ueenm Law for the
vt
00 following mason.(Section 7071.5,Business and Professions Code:Any city or county
3$ which rtquires a Parmil on construct.alter,improve.demolish,or mini,any suucum
prior N is issuance.sso mquirts Ne applicant for such permit ar file a signed sumacnt
H�O then he is licensed Invention to the p,oviaiomof Ne cWmaLtues Licans,Law(chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of diva Business and ProRsamis Code)or $500000
5 2 that he is esempl Nuefms tib Ne basis for We alleged eaempth n.Any violation of
Section 70315 by any applicant fm a Permit subjects the Applicant w a civil penalty ofNumber Occas
not mom Nan Bae hundred do]].(S5W. 37503022 :CT(]' Occupancy Type
L rim we of and
Property,err my moploym with wage u Ness sok eompenydon,
will da professions
wont and e: he Contcoure ravenes
Li dome sew du trestlepply in an Business
and property
who bu Cede:The ConmcNrs License law does nark apply to an owner of Required Inspections
pme em who builds orbnpmw Nucor,and a who diessuchworkl oro ff mdNmvgh his
awno.,th Wilding
prsuchimpmwmenuartrotea:Me1oroRued far me a,.however,the bin OiL m improvement is old within one year of c prove our the owoer-
builder will haw Ik bother of proving Nat K did not build or improve far puryou of
ask.).
0 1,u owner.of Ne properly,am esdmively contracting with licensed conmcros Is
construct Ne pmjem(Sec.7004.Business and Professions Cade:)The CommcMe3 U. .
ase Law doe not apply in an owner of property who builds or improve thereon,and,
who concocts for such prejecs with a eonuacmr(s)licensed pursuant m Ne Contractor's
Lkeme Law.
❑I am aempt under 5m. .B A P C fm Nds maven
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby alfitm under penalty of perjury oro of Ne following Eecluvionc
I hsw and will mainWa a Cuufiem of Coment m mlf.imum for Workers C=Nn-
as ion,as provided for by Beeson 3700 of the labor code,for the performance of Ne
work for which this permit is issued.
0 1 have and will maintain Workers CompeasNon Insurance,as,wired by Section
7700 of Ne LaMar Cade.fm the performance niche wort for which this Permit is issued. '
My Workers Compensation Insurance artier and Policy number ve:
carrier. 4g-Atk 1.14' Policy No.: 13 —20S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cans savor need col be cmnpkmd Bede permit is fmmnc hundred do0an({IU0)
or ken)
1 certify Net in the performance of the work for which Nis permit is Lased.I shed not
employ anyperson in any manner Is,as to bemme subject N Ne WoNmi Compi mmon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making Out Certificate of Exemption,you should
beeome subject in On Wotrcrs Compensation powisions of Ne lahor Code,you must
0 forthwith comply with such provisions or Ns permit shall bed md
e deemate
z CONSTRUCTION LENDING AGENCY
I hereby M.that Nem its communion lmdinppenry for dm performance of
TL> um wort for which Must puma Is,issued(Sec.7097,civ.C.)
a Landers Name
D z Lenders Add.
C)Q 1 mmrify Nat 1 Mw mad W,application arta sum Mas Ne show information s
!' correct.l agree to comply with ail city and county ordinances and sum laws misting,to
Q CrJ^ building construction,and hcmby auNome representatives of this city to enter upon Ne
r W above-mcmioned property for de p meact purposes
(•+ gy (Wa)aprte to ave,indemnify and temp hanky de Gly of Cupmtfno against
fA incaummar mens,case and espcvmeaft. may in anY way accrue against said Clry
()z in co,tsegncnce of Ne{ranunt of Ns permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: al e
SOURCE REG"TIONS.
_ �hg& (Gcam ate Re-roofs
"
Si{nalu¢aglgipl HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building acupanssmre or handle haunch us material
u deflmd by ds Cupertino Municipal Cade.Cbapm,9.13.and Ne Health and Safety
cork,Series u532(07
41 ❑Ye �Na All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne applicant or futon building by the B era equipment or devices which P g
emit ick? us air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
P
❑Yes /{/-�No
1 have real Ne hva,dbusm=dr mquimmcnuunderChapurG95ortheUifor-
nsHe1NorreadYban1retiw2adIti2my and25534.1 undenstvWe occue Wilding,
dna rot LumnIt haw 1 Ienane NL It i su rese ofd Ceily m notify the aa'upmt of the
myulremcnu wh' muss Mmes pniormiuuan¢oro CodBcam of OccuyN / Signature of Applicant Date
b l� a
owner o,anNar Dam All roof coverings to be Class'/W'Or better