06020129 CITY OF CUPERTINOI(�`^ :
BUILDING DIVISION "
PERMIT CONTRA6TQRgNF AT �V
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Bu1LDINGADDRESS: HORIZON ENERGY SYSTEMS PEaMITNO,06020129
20832 GREENLEAF DR .
NER'S NAME: PERMIT ISSUE DATE
CHARLES OLSON 440 SALMAR AVE - 04/05/2006
ONE:- SANITARY N0, CONTROL NO.
(408) 395-9060
ARCHITECUENGINEEN: BUILDING PERMIT ,
' BLDG ELECT PLUMB
MECH
C=
�oZ LICENSED CONTRACTOWS
under providence
DECLARATION Job 1 II�
rd e .7 affirm Nall licensed Bu undernd Prolns MChapter 9(myIf..I. YrA{l��®
fO
with Section]IXM))of Division 3 aide Budwa uM Pro(eadons Code,aM my Iice�u
In full force ontl,ffec- C9L gy9q)A SOLAR MODULES
z Llcenc Clw Lie.
Dem CaMouse
understandA " be,nSDECLAR 01 MAYS- 1006
1 understand my PlanssCHII k wed u public records
J
W
Licensed erebsdonal gy ILD'
�8 OWNER-BUILDER DECLARATION U
I hereby affirm that 11. exempts an the Cenoaners License 4w for tic ■■YYYr���sa///'•_
O following won. emit b]113L5.Business and Pnsfesdons Cede:My oily or county
$
which mqui issuance,a a permit re ewwroe4 pHr,improve,demMbh,ri rtpalr any toumuw 4 6 6 5(]
pdormits ecduruarequires the applicant for sohmpermit esL file Law(natemcm
ss< tiwheiaccenscd pursuant to the provisions the Comrsomh LIcensc Hw(CHpter9 Sq.FI.Floor Area Valuation
p$ that he s(commencingwith Section7000)and
MDiviis I&the
al Business and lhofwfavi Code)or
33 Uu0 H is exempt OHrefrom and Ne buss fw Ua alleged esempUoa Any violation of
Section 7031.5 by any applicant per.permit mbje es the.pplmant 70 a civil pensity of rLIT Occupancy Type
sat mem than ftve hundred doll.($500).
Q 1,uowwroftie property,wmy wplayes,with wagesu ue0solemmpewum,
will do he work and the swcome is not Intended creRered fertile(See.7044,Business
and Professions Cede:The Contrscmrs Clause law don not apply be an owxr of Required Inspections
property who builds ar f mprowa dereon,and who dos such work himsel f w d s ough his
own employees provided that such improvements.not intended oroRered for ale.11.
hwvever,the building or bni mv.mt is sold within cons year of mmpletim.Ne ownw-
Wilder .will have she harem of peeving Nat he did not build or Improve for purpose of
amJ.
❑1,As owner of thee property,am exclusively contracting with licensed contriteness m
construct the project(Sec.7044,Business and Profession Cade:)The Conoacmr.U.
mnse law dust not apply m an owner of propenywho Wild,w impeewa Uemon,and,
who convects for such projects with a cte o.cter(s)licensed pursuant to de Conuamoes
Liana law.
❑I am exempt under Sec. ,B&PC for NB won
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby"Bim under penalty of perjury,ow,of Ne following deciva0ons:
❑Ih.mmd will mdnuln.Cmd5comof Consentmself-in.umfwWwkeraCompcn-
ation,u provided for by Section 5700 of The labor Cods four the padommtce of the
work for which this permit Is issued.
❑1 have and will mdnuln Waters Compensation Insurance,a required by section
3700 of the Labor Code,for the performance of do work for which this permit is issued.
My workers CmnpeuNon�lku�unntt"mer and Policy number.:
Cartier. :51-AW 7 P)IIcyNo.: 7.? 20'sa O '0 2_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThRactim stood not be completed if tie permit B foronchundmAdoll.(SIM)
or lest)
1 certify that in the perfwmsace of the work for which this permit is issued.I mail not
employ any person in my manner an As ke become abject an the Wod¢tesCmnpewdm
Laws of California.Data
Applicant
NOTICE TO APPLICANT,If,after making this Compute of Exemption,you should
become subject an Ne Weaken's Compcwdon proelaions or the labor Cods you mol
.J O forthwith comply with such provisions w Nu permit""k comped!renounce.
z'" CONSTRUCTION LENDING AGENCY
Ikreby)Rum that there ii a coonectinn food,
for des poformams of
LYi,•�„ the work fur which this Permit Is issued(Sec.3097.Civ.C.) _
aLanders NAro ,
r7 z Lentlere Add.
U0 1 certify that 1 hove read this application and state Nat due slow informnim is
Da !" cone"I Agree m comply with dl city and county oNinm¢s coal scale lam relating an
0 Wilding construction.and hereby authorize representative;of this city an color upon tie
W .hove-mentioned property for hips ction Purposes.
pL (We)agree to on,indemnify and keep harmlw the City of Cupcnino against
cn Ilabilities,judgromos,cow and expenses which may in my way Accepts against said City
U 7 in consequence of Na gaming of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA ONS.
Re-roofs
Signatureo pphanryCantnctw Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do Applicant or future Wilding occupant nom or handle hmardous material
A,defined by Ne Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety
edea Sceue.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Eyes AN.
Will Ne Applicant or future Wilding occupant uses equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hax Menus air contaminants As dented by the Bay Area Air Quality Management all new materials for inspection.
Dlnrict7
[:] (�u
I hero mad Ne We rdou.materials requirements underChapter 6,93 of the Califor.
nia Health&Safety Code.Savants 25505,25533 and 25534.1 monaural tit if use Wilding
does not currently haw a tensna Nu It is my rapaalhility an notify the occupmt of the
requirementswhich on be poor m issuance or a andscam of Occupancy. Signature of Applicant Date
y—SSv C.
Dancer or w rind scat Dam I All roof coverings to be Class"B"or better