03070023 CITY OF CUPEWrINO
BUILDING DIVISION PERMIT• 01 ' 4V
BUILDING ADDRESS: ALTEN PRODUCTS CO PERMIT NO 03070023
:�02F�2 211-TICK- W24
OWNER'S NAME: 2423—J OLD MIDDLEFIELD WAY PERMIT ISSUE DATE
E: SANITARY NO. _ 'CONTROL NO.
(650) 960-0760
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION �bDCSCrI tlOn
<� I h rcby a :rte shat)l am lianad unJr�r provisions"f Chap¢r 9(coY mcncing Fg P
Sz with Se UO tof Di vis on Sof the Ouvn and Profcs mruC e.a ¢crtu is
inch Sfort- fie '
;'q= ucenu — r[.a SOLAR POOL HEATING SYS
m Cunt airJUL Z�Q3
ARCHITECTS DE AR ,1U 1 L
> U 1 nu 0 my Planx sMll be used as Pul)!i'rccnrd '
goG
Licensed Professional JWpl■fl IMG
` 3 OWNER-BUILDER DECLARATION
8 I hereby affirm that I am exempt from the Contractor's License Law fur the
OO rollawing reason.(Section 11131.5,Business and Pmresskuh Code:Any city or county
<m 1� which¢quires a permit in coaetnam.alter,improve,demnlixh.Lir repair any xwctum
°it prions its issuance.also requires the applicamforsuch permittu flea.signed statement
< that he islicented pursuant tothe porivisions of the Contractor's Liamse Law(Chapter 9 Sq. Ft. Floor Area Valuation
YFO (commencing with Section 7000)or Division 3 of the Business and Pmfecsions Cmde)or
4�3 Nat he is exempt Bu mfmm and the basis for the alleged exemption.Any violation of 36936010 . 00
Section 1031.5 by any applicant for a permit subject the applicant o a civi l Penalty of APN Number Occupancy Type
not more Nan Live hundred dollars($500). P Y YP
❑I,u minor of the property,or my employees with wages as their sole compensation,
will do me work,and the structure is not intended or offered for sale(SM. Business Inspections
eCt10n5
anti Professions
ns Code:The Contractors Licenu Law docs not apply to an owner or 10 2 — PIERS P
p paryw builds of improves Hereon.and who does such wart himself or through his
own employees,provided that such improvements are not intended or offered for ula.U. 103 — UFER .
however,Ne building or improvement is sold within one year of completion,Ne owner.
builder will have Ne burden of proving that ne did not wild or improve for puryasc or - 1.0 4 - REBAR
1a1C) 105 - ANCHOR BOLTS
❑1.o t the project or property.am adusiv ad contacting with liars Cconvectors to
or..cometaNech . ..lyto Anownsiness erofprod Pmmssiouo Code:)Thew.therma,a 106 - SEWER & WATER
cotelaw docsnouPp r mire with
armfprogeny who wildsorimproves Nneracand 202 — UNDERFLOOR PLUMBING
who contracts for such projects with o[onVaztor(s)licensed pursuant m the Contractor
`"` me203 — UNDERFLOOR MECHANICAL
0 Amexe:empwndersee. B&Pefar Nisrcasmm 204 - UNDERFLOOR FRAME
Owner
Data
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
tI hereby.mrm under pc"arty of perjury ore or the(allowing declarations: 301 - ROUGH PLUMBING
obanand will maintain a Chodicate of Consent se04maure for Worker',COnPen- 302 - TUB & OR SHOWER
setion,m provided for by Section 3100 of the labor Code,far the performance of the 3 03 - ROUGH MECHANICAL
work far which this permit is ish.d.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 04 — ROUGH ELECTRICAL
noomrNe labor code.for Ne Performance of Ngwgrk for which Ni,permit i,issued. 305 — FRAME
M Workc's�jnrcmado nsu,ancccaricran�.�l,�ynumberam: 306 — HOEDOWNS
Ca 't'I Policy No.: _
CERTI�CAM OF EXEMPTION MOM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
it Be..)(Tris section recd not he completed if tan Pamirs mr-one hundred dollars l$100) 309 - EXTERIOR LATH
:
1 Lenity that in the performance of the work for which this Permit is issued.I shall not 310 - INTERIOR LATH
employ any Person in any manner so as to income subject to the Workeri Cnmpemammn - 311 - SCRATCH COAT
Laws of California.Dare
Applicant 313 - ROOF NAIL
g NOTICE TO APPLICANT:It.after.making this Cent fiLsmofExemption.you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation provisions of the Labor Code,you must
JD forthwith comply with such p,.vision,or his Nor Ithat lwlearned revoked. 502 - FINAL PLUMBING ENERGY
z� CONSTRUCTION LEND INOAGENCY 503 — FINAL MECHANICAL ENERGY
N
F Ihereby offrmatthem isaconstructmnlending agency for the Per(urmaareof 504 — FINAL BUILDING ENERGY
a Nc work for which this permit is issued(Sec.3091,Co,C.)
a p 1<mder:Nam[Loo505 — FINAL ELECTRICAL
Z aeraAddresa 506 — GAS TEST
U O 1 ccnify Nat 1 have mad this application and sate that the above information is 507 — FINAL PLUMBING
Iy I~ cored.I agree to comply with all city and county ordinances and smte laws relating to
pU Buildingconswctimn.andhcrebyamhorir<rcprcunutivcsofNiscitytocnmruPnnthe FINMgWNG
GAL -
ahovc-mentioned Property far impcnion Purposes. JtVO 9 F I
P. (We)agree u save,indemnify and kttP harmless the City of Cupcninm against
(Z) liabiliticu.judgmcn¢cost andcxpc which may in anyway accmc againstsaid City
U Z 100 Lmn en a Lie gr nuns un ,perme. 5 APP CANTrID NOS ND WIL OMPLY WITH ALL NONPOINT Issuedby:5 WORKS Dale
S R REG IONS. '^3
gnaturem pPilean m car D I/ Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
Will the applicant ur for..building occupant store or haMlc ho—d! material
As defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Scction25532(.)?
❑Yea All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ter more wilding Occupant use equipment ter devices which If a roof is installed without first obtaining an inspection, I agree to remove
41itittrict?huxnNnus air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
s
❑Yes I<No
I have read Bic hamrduus mrials requlroments under Chupmr 6.95 of Nc Califon
ffl.4y
,Sado AIS. and 25534.1 undcrsund Nmif Nc willing
Nat It I MiI11 i1 m nodi t [u 1.1 du
sta rcsoaCcLa¢m Signa[ureofApplican[ Date
ger All roof coverings to be Class "B"or better
SIMCfY OF CUPERTINO •
CITY OF PERMIT APPLICATION FORM 2-3
CUPERTINO
N4 Date:
Z
Building Adds: J
Owner's ame: [, fho #:
Contractor: License#:
Contact: Cupertino Business License#:
G6A-u<
B Permit Info:
Bl lecf Plumb, Mech Elbb D crip ion:
6 ��
Residential 5 Commercial ❑
Sq•Ft. Floor ea: $/Sq.Ft.:
Cost of Project: �/ Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bld Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 5 O Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler>HIM 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75MBtu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 flee 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Ener BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee T BUILDING
,,l 2 �3 7 0
1 of 3
3 2 7 / Z-
CrY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL
BREMAPPLI A liance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT Li tin Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A azatus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
Sd i CITY OF CUPERTIA
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Grou
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
Compool LX220 Solar Contra/System ;
A
y
r
LX-220 SOLAR CONTROL
(-vacuum Relief Valve
POWER ON �`. WARM '. v
4 O� A SO"A ON Solar
ON O naar.n 71 Collectors
vu..uwre i,,
•��Mm
Solar
ert¢.am le COOL HOT.
Sensor
WATER FLOW w vao.d WATER
TO PANELS n.A. •.ae a TEMPERATURE
Effective and Economical Heating
The/,x220 control panel lets you set your desired
pool temperature,then automatically sends water to There is generally no need for an
the solar collectors when conditions are just right. additional solar booster pump.
Filter cheek Solar With the Lx220 system,your
_ Valve Valve
cva-'ITCheck existing filter pump is used to
Filter Valve e Heater pump water through
Pump water the solar collectors.
Sensor
Suction Return
(cool water) (warm water)
Swimming Pool
The Compool PTV-2TS Solar The CVA-24 Valve
Valve is the only one of its kind Actuator is built to last,
• to automatically drain the solar with sturdy steel gears,
collectors when the pump shuts a reliable low-voltage
off. Il also features a durable motor,and a weather-
'I'eFlon®seal which offers years proof composite
of maintenance free operation. enclosure.
Lx220/2Tx System Includes Additional Features
LX-220 Solar Controller. Pool Cleaner Protection- Protects pool cleaner pump from
CVA-24T Valve Actuator. damage caused by air in the solar collectors at start-up.
PTV-2TS 2" Solar Valve. Requires relay kit RLY-SC.
TS-5T Water Temperature Sensor. Solar Booster Pump- For use in systems Which utilize a
TS-5T Solar Temperature Sensor. booster or independent solar pump. Booster pump is activated
when solar energy is available. Requires relay kit RLY-SC.
Accessories Pentair Pool Products Pentair Pool Products,West I�
OND Solar sensor hook-up cable. 16201 lawkins Ave. 10957 West Los Angeles Ave. E
Sanford,NC 27330 Moorpark,CA 93021
IW-56 FI¢CtrIC drain-down VdIVe for glazed COIIeCtors. Phone(800)831-7133 Phone(800)831-7133 ,
RLY-SC Relay kit for pool cleaner or booster pump. Fax(919)7744841 Customer Service Fax(800)2844151 II "p
httplAvww.penLairpool.com 0
Copyright 1998,Compool,Inc.Teaoo is a registered trademark of DuPont' 0 2001 Pentair Pool Products 9430809 02/02
C, ampool Lx22oJ.
Solar Control Systeml,
At some ninety-three million miles from Earth,
the sun still offers the most cost effective means ofd'"' . .��
heating your swimming pool—provided its energy
u`
is harnessed properly. In addition to correct
sizing and placement of your solar collectors, the
Lx220 Solar Control System plays a vital role in
achieving maximum solar heating efficiency.
I
Like your home-heating thermostat, the Lx220
System provides you with a variable thermostat
for solar heating your swimming pool. You simply '
set the Lx220 Controller to a comfortable
temperature, and then adjust your filter pump to
run when the sun is out.
4- Easy to use Controls
Maximize the Sun's Offerings.
Day in and day out, the Lx220 monitors the
temperature of both your solar collectors and your Adjustable Thermostat
pool. Whenever the sun offers sufficient energy _
for effective heating, the Lx220 opens a motorized • Ilable�Sb�ll [� IYCultry
valve, sending filtered water to the collectors. ••
Should clouds or wind interfere, the Lx220 shuts ® �
the collectors off, keeping them from cooling your JUL
ggd Co E
pool, much the same way a car's radiator cools an eosite losures
engine.
If you are looking to extend your swimming mot r ed halve with TeflonPSeal
season, then the Lx220 is even more of
an advantage. By knowing precisely
when solar heat is available, the
will get your pool as
warm SUBMITTAL pBMITT ��y 1
L
warm as possible, in the �I � -
shortest amount of time.
As the pioneer in automated
uaao wtu cowt�o�
pool/spa control technology, • _ . •
Compool has designed they
Lx220 with reliable micro- z• "
electronic circuitry, housed in
rugged, fiber-glass composite Compool o
enclosures. The system even
monitors itself, making sure that
the temperature sensors always
function properly. z
Enjoy a more comfortable and
carefree pool with an Lx220 Solar
Control System by Compool.
Lx220 Controller, Value& Value Actuator
r MUM DERIU ] TOM 000001 SOLAR INDUSTRIES
MENEM GUIDE SPECIFICATIONS
Contractor to supply and install collectors,nominal size
SI Solar (4'x 12",4'x 10",4"x 8")with overall frontal area of(47.3,39.3,31A)
Collectors square feet each. Collectors shall be fabricated from a propylene
copolymer with stabilizer combination providing long tenn resistance to
heat and light.The weight o1 collector when filled with water shall be no
Solar more than 1.3 pounds per square fool of frontal area.The collectors
Sensor • shall be capable of withstanding an internal static pressure of 85 psi at
operating temperature and shall be resistant to corrosion,freezing,and
internal scale accumulation.
Collectors shall be capable of thermal performances of at least 85%
Solarsefficiency when inlet fluid temperature equals ambient temperature and
Electronicat-
be capable of collecting scar energy when the inlet fluid temperature
Electronic Isolation Isolation exceeds the ambient temperature b 60'F with 250 BTU per square
Control Ball Check fool per hour,
p y p q
Valve Valve
("..p IoW 4 Pressure head loss of a single panel must not exceed 0.30 feet water
Pool
Water r______...__T at recommended flow rate.
.
Sensor Heater Collector mounting center shall be 51 inches.
roman Collector mounting shall consist of 18.8 chromium-nickel stainless
Pump Lir-- ---Trr steel mounting hardware with two continuous transverse straps having
1
Filter black polypropylene coating.Transverse straps shall be fastened with Check Motorized 18-8 chromium-nickel stainless steel clamps and brackets.
Valve Divener Water connections shall be made with hose sections extruded from
Valve EPDM(ethylene-propylene-diene terpolymer)70 dummeter minimum
hardness.Hose clamps shall be all stainless worm gear type Nth 18-8
chromium-nickel stainless band.
COLD POOL HEATED The collectors shall meet a exceed the minimum Standards established
WATER WATER i by the Florida Solar Energy Center.SRCC,and other applicable nationally
recognized standards,and shall be manufactured in the U.S.A..
� D lY1nLT CA�lnLS L'�CL� l�lY "' 1 O�
• � O O � �C11 O O '
5 12 COLLECTOflS 100
4
80
90
QL \
d 10 COLLECTORS ^ 70
F
3 }
W U so
W50
LL W 50
Q 2 8COLLECTORS V 40
Q LL \
W W 30
_ 6COLLECTORS \
1 20
10
0
0 0 10 20 30 40 50 60 -.10 0 .10 .20 .30 .40
FLOW RATE-Gallons per minute tf i - to OF-HR-FT°
I BTU
THERMAL PERFORMANCE RATINGS
Thermal Performance Equation - in =85.8 - 3.42 Florida Solar Energy Center Certification
Incident Angle Modifier- Ki= 1.0 - 0.03 (BTU's per standard day)
(Rated in accordance with ASHRAE standard 96-80) 4 x 12 -47,200 4 x 8 - 31,500
4 x 10 - 39,300 4 x 6 - 23,600
Available Through
Sid(a r
DnduWrk.Q.)s
Solar Pool Heating Systems
Part No. 19280-1 0 11/96 Solar Industries Solar Pool Heating Systems
01a,
Industries
�t industries
00 d p M p 0 0 d M E p 4 0 Z T T W IJ Gl
q . SI 1500 v
he Lea or In Pool H his ///yyy
for 7Wonty-Flue Year. Solaf Pool
Healing Collector o
o Low Profile Design - y-
for an unobtrusive installation that
sheds debris and water easily.
o Patented Tube and Curved Web Design - INSTAL AT[ON MATERIALS
relieves stress caused by expansion IS U e er with synergistic antioxidants
and contraction for longer life. f.«; an screen me uding carbon black.
o Stainless Steel Mounting Hardware- own Straps
•Pprylene coated stainless steel(Type 302)
greater strength and rust free with fewer •Connecting Hoses
mounting points for easy installation. EPDM (ethylene-propylene-diene-terpolymer) .
o All Welded Construction - •Clamps and Brackets
for maximum strength and durability. Stainless steel (Type 302)
o Made in the U.S.A. Since 1976 CERTIFICATIONS, APPROVALS & TESTING
The Solar Industries solar pool heating system meets
and backed by a Limited Lifetime Warranty. or exceeds the criteria for approvals from the following
accredited independent laboratories and approval agencies:
•International Association of Plumbing
and Mechanical Officials(IAPMO)
•Florida Solar Energy Center
•Dade County
Collector Cross Section showing heat trap design •City of Los Angeles
•Solar Rating and Certification Corp. (SRCC)
D TA •Testing: DSET Exposure Test, New River,Arizona
-T-ECH�I ICAL
DIMENSIONS /� FLUID FLOW RATES
Model Number 11051 11001 11012 Maximum-GPM 10.0 10.0 10.0
Nominal Size-ft. 4 x 12 4 x 10 4 x 8 Minimum-GPM 3.0 2.5 2.5
Overall Collector Length-in, 144.0 120.0 96.0 Recommended-GPM 5.0 4.0 3.25
Collector Width-in. 47.0 47.0 47.0 Max.Collectors with Single
Manifold Length-in. 50.5 50.5 50.5 Feed @ Recommended
Manifold O.D.-in. 1.9 1.9 1.9 Flow Rate 10 12 12
Manifold I.D.-in. 1.5 1.5 1.5
Gross Collector Area-ft' 47.3 39.3 31.4 PRESSURES
Net Collector Area-ft' 47.3 39.3 31.4 Pressure Drop 0.30 ft.head(0.13PSI)pressure loss ® recommended
WEIGHTS flow rate.0.20 ft.head(0.09PSI)pressure loss
minimum flow rate.
Dry-lbs. 21.3 17.1 14.3 Max.Fluid Pressure Greater than 85 PSI @ 80°F
Wet-lbs 48.0 41.6 35.1 Recommended Max.
Wet-lbs./ft' 1.01 1.06 1.12 Operating Pressure 35 PSI ® 140°F
Fluid Capacity-gal. 3.2 2.9 2.5 Specifications subject to change without notice.
COM
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Sd !4"c 02 2003 V
By
i
SUBMITTAL
`7-�LA--;u VIal
APPROVE®
IN ACCORDANCE 'TN T CITY 09
CUPERT, C AND / DINANCE9
DATE I
"'�.SIGNEU�_
This set of pla , and specifications d4lIS7
be kept on t job at all times and it is un
lawful to make any changes or alteraficros
�✓ l without written permission from
/ the buil 'ing Dept., City of Cupertino,
e aarnping of this plan and specifications
SNAL NOT be held to permit or to be art
spproal of the violation of any provtstons
if en City Ordinance or State Leal.
•
I
0
CI'T'Y OF CUPER'rlNO 7 �' n8�x vi. :-
BUILDING DIVISION PERMIT €CONTRACTOR=INFORMATION �.
."ILDING ADDRESS: ALTEN PRODUCTS CO PERMITNO 03070023
0252 C,1T,TTlQ-K WY
OWNER'S NAME: 2423-J OLD MIDDLEFIELD WAY PERMIT ISSUE DATE
E: (650) 960-0760 SANITARY NO. CONTROL NO.
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
r---1t� l� t�
goo LICENSED CONTRACTOR'S DECLARATION
m I h Is afrrm mal l am littnsed and vsmns of Chapter 9(commencing Job Description
4iW with Scmtion B
."Mus. 30f=.-u CPra(c cost is
`` �2.. SOLAR POOL HEATING SYSTEM
am Can tar
ARCHNT'GE AR
� PT
U br
1 ata dmyplam shillM usedaspu rccnrJ
"� Licensed Professional JUL 1 1 2003
5 OWNER-BUILDER DECLARATION
<y I hereby affirm that 1 am exempt from the Contracmr's License Law for the
O BUILDING 0 following mason.(Section 71131.5.Business and Professions Code:Any city or county
5 m which requires a permit to construct,allot,imprnw.demolish,or repair any structure
_Zr priorto its issuance.also mquires the applicant for such permit to file a signed.statemenl
ESG that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
yl- (commencing with Section 7WR of Division 3 of the Business and Professions Code)or _
i that he u eaompt memfmrn and Be basis for the alleged escmpuon.Any violation of 3693 6 01
Section 7031.5 by any appliantfor a permit subjects be applicant to a civil penalty of
oAPN Number mre man eve hundred dollars(SSOKB. Occupancy Type
❑I.uowncr Cir the property,or my employees wim wages as their salt compensation, (�T�T
will do the work.and mcstruchare is not intended or offered for sale(Sec.7044,Business 101 - FOUND
rylTed Inspections
and Professiou lam Code:The Contractors License w docs not apply an owner of
property who builds or improves thereon.and who does such work himaclfor through his 102 - PIERS
own employees,provided that such improvements are not imenhd or offered for sale.If. 1O3 - LJFER
however,the building or improvement is sold within one yeu of completion,the owner
builder will have Be burden of proving that he did not build or improve fur purpose of 104 - REBAR
Sala.).
❑1.as owner or the properly,am exclusively comncting with licensed contractors m 105 — ANCHOR BOLTS
consumerthe project(Sec.7Ds4,Business and Pmfeaalona COdo:)The CombeCom's Lt. 106 - SEWER & WATER
cease law does net apply to an Owner of property who wilds or improv daemon,and 202 — UNDERFLOOR PLUMBING
who contracts for such projects witha outuacinr(s)licensed pursuant t0 he Comamc,m's
L1CUo.Ldw' 203 — UNDERFLOOR MECHANICAL
C3I sur exempt under Sec. ,B h P C for this moon
r Data 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
1 hereby affirm under penalty of perjury one of me fallowing eteeluatiov: 3 01 - ROUGH PLUMBING
I bav and will maintain a CcniEcam of Consent to SCI Nature for Workers Compcn- 302 - TUB & OR SHOWER
cation.as provided for by Saturn 37W of me Labor code.for the performance oldie 303 - ROUGH MECHANICAL
work for which But permit is issued.
0 1 have and will maintain Workers Compensation Insurance,as inquired by Second 304 = ROUGH ELECTRICAL
3700 of be labor Code.for the performance of _ _rk for which this pe.it is issued. 305 - FRAME
MyWork a atm naa eariera�ynamxram:
306 - HOLDOWNS
Ca Policy Na:
CEBIT KATE OF EKEMPDON FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
m has.)
section need not be completed if the permit is for one hundred dollars(S 100) 309 — EXTERIOR LATH
1 eatery that in Iw serfomunee of the work for which this permit is issued.l shall nm 3 10 — INTERIOR LATH
employ any person in any manner.masn,wnamc Subject o the Workers Compensaimn 311 — SCRATCH COAT
Laws of California.Dam
Applicant 313 — ROOF NAIL
NOTICE TO APPLICANT.If.after.making this CenlrCaLC of Essemplion,you should 501 — FINAL ELECTRICAL ENERGY
become subject m the Workch Compensation provisions of me labra Code,you must
O rorthwitheamplrwnhx hprnvitiantmmiaprmaxmnbdamedrcvmken'
Z502 — FINAL PLUMBING ENERGY
Z "
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F� I hereby affirm Nat there is a cmuouction lending agency for tw rcrformance of 504 — FINAL BUILDING ENERGY
C' > the work for which this permit is issued(Sec v.C
JW7.Ci )
a
Lenders NameLai - FINAL ELECTRICAL
P Z nder'sAedrcss 506 — GAS TEST
U Q 1 Certify Bat I have mad this appliaalimn and stain that the about information is
ly� correct,l agree to comply with all city and county ordinances and sum laws misting to 507 - FINAL PLUMBING
0 wilding Construction,and hereby amhome representativcs Of this City to enter upnnum FINM&TNWG
AL
awvamentioncd property for inspccuan purposes.
H LL (We)agree to save,indemnify and keep harmless me City or Call, a against O 9 FI
y leabues,jidgmcnls.costs and ea which may in any way accrue against said City 5 z Ll in con en o be gr ling aft s i,crmit.S Pon FG D IONS.NDS ND WIL OMPLY WITH ALL NON-P INT Issued by:5 ORKS Dale
gnamrco pplica nt tar D Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant or future building Occupant store or handle haa4Auus material
as deeded by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
[D yet
Will the applicma or future building occupant use equipment Cir devices which If a roof is installed without first obtaining an inspection,I agree to remove
n lm and 5 air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
tstr;ct?
❑Yes J(7 Nn .
I have mail me hwardmus mriall requirements under Chapter 6.95 of the Calif.,
niaH Safnyc .Sectio 515, and25534.1unkoCodmmifmc wilding
d not eddy thin its nsihilitymnntil In(Be
he I 'h mon a l art„1 or.
CNres.
Signature of Applicant Date
Ow aumoriaedagen Date All roof coverings to be Class "B”or better