08080027 CITY OF CUPERTINO -rnl�a z: #>; I , '"''' "' �"
BUILDING DIVISION pERNIIT CONTR'OTORINFORMATIO
BUILDING ADDRESS: PERMIT NO.
19973 HALL CT SOLARCITY 08080027
MINER'S NAME: PERMIT ISSUE DATE
JOANN YAMANI 393 VINTAGE PARK DR STE 1.4 14 2008
"ONE: SANITARY NO. CONTROL NO.
(650) 638-1028
ARCHIECOENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
up o LICENSED CONTRACTORS DECLARATION lob Description
�u 1 hereby affimthat t 1 sm licensed under provisions of Chapter 9(commencing p
�+ withSoodon7")ofDiviuon5mftheReal.andPmfcssiomCade.aMmyliccnwts 2 ,46KW RF FLSH MNT PHOTOVOLTAIC SYSTEM
in full farce and effect.
License Claw. C<i/ r in Lk.N
ot,p Dam Con Dow
ARCHITECTS DECLARATION
I�< I understand my plans shill he used an public necordr
Dyu
k o� Lieenwd Professional
OWNER-BUILDER DECLARATION
g1 hereby affirm Nat I am exempt from the Conuactoes License Law for the
O following resume.(Section 7051.5,Business and Profecsiom Code:Any city or county
$� which rryuiren a Permit m examines.about,improve,demolish,or mini,any awctma
Z< pnorwitsissuawe.ewm ui=A applicantforsuchpcmiiwfilaasignedsummem
�C Nat heis licensed pursuanttothe provisions ofthe Counter's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 5 of do Busineas and Professions Code)or $11000
$ that he u eumpt Undefroa and the basis for the alleged eurepuon My violadan of
Section 7031.5 by any applicants for a permit subjects the applica a to a civil penalty ofNumber Occupancy Type
not mart than five hundred dollar(5500} 3 6 9 0 4 0 51 .ql'
0 I,u owner of the pmpcm.m my empleym wish mgr u ftkwk eompemom.
will do the woh and the rmucws is not intended or offered for We(See.7044,Buimas
and PmfeVION Codc:The Contractor!License Law dam Mt apply in w manor of Required Inspections
property who builNorimpmvea dEercon.andwW daearushworkhimselforduvu{h but
own employees,provided that such improvements Me not intended oroRemd for We IL
however,the building or Impmvemwt is sold within one year of completion,the owncr-
Wilder will lave the Wrde t of proving this he did not Wild or improve for putpmte of
.I.J.
❑1.u owner of the property.am=elusively contracting with licensed contaacrm Ed
cmutmct the project(Sec.Told,Business and PrEfessimu Cade:)M Commu ars Li-
«me,law does not apply m an owner of property who Wilds or improves;thecon,sod.
who contracts for such pmjcm with a eanuaetur(s)licensed peou ant to the Contractors
License Law.
❑lamucmptunderSee .B&PCforthutrssaa
weer Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury roue of the fallowing dxlantimu:
1 have and will milnuin aCenificeteaf Content m alf-iuum for Wm4Ys Camper- '
worstsn,u provided for by Section 3700 of dp labor Cade.fm tis perfarmance of IW
work for which this permit is issued.
Xhave and will minu
ain Wurtcrs Comperuation Insurance,u mquimond by Socuof the labor Code,for the pertormanec of me ark far which this permit is issued.
My Wonoe,Cmepenaauon Luurwa camiu and Policy number art:
Cartier:IYI�IP Si'i.C'� Policy No.:
�IFICATE OF E(EMP ION FROM WORKERS
COMPENSATION INSURANCE
(Thb xNrn need wtbecompleoud If us permit is fmone hundred dollars(SI00)
or less)
1¢nifv Nm in the perfamenewe of do work for which thin permit is issued,!shall not
employ any pawn in any matter w as m become wbjert in the Woh Compew0ed
Laws of California Date
Applictnt
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the worker's Compensation pmvisome of the labor Code,yen mom
.,z forthwith comply with inch provisions or this Permit Mall be doomed UnAcd. _
z O CONSTRUCTION LENDING AGENCY
I hemby.firm that Nem u a coEmmnion lending agency for the pMmcn.Of
D dou wen for which thin Permit is ismidi(Sec.5097,Civ,CJ
W�A Lender's Name
7 Z L does Md.
U O I certify Nrood at 1 have d this application sod sur Nat ab
at the ove information u
L. E cmRct.l agree to comply with all city sousu
d county onliand sum laws rem
lating
L]SCJ' Wilding constnstion,and bemby authorize mpmunuuron of Nu city m enter upon 0s
W shove-mcnuonedproperty for inspection e ..pimpowhich may
glr (We)agme to an,indemnify sod keep harmless the City of Cupertino against
(n in
f thecasesod grommif Of thus..mit. mey in any myamts agilmtraid City
U 2 APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
1r),O Y1p ep n'Q '6113 1db Re-roofs
Signature ofAppliauV onumxw �
—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or form Wilding aaepant more orlundle hvallou material
u deOnN by the CuPcMdd Municipal Code.Chapter 9.12,and thc Health and Safety
we, on zss3z(.)7
ou All roofs shall be inspected prior to any roofing material being installed.
Y �Nu
Will tete. IILNt of f'YIOR Wlldle Occupant use equipment If a roof is installed without first obtainingan inspection,I agree to remove
IIP g e 9 p,Q.or Mann which p
Ir hmaNnun air canwnimnu u defined by the Bay Area Air Quality Management all new materials for inspection.
nT
❑Yo A.
I have mad the huallousmawriala ne uimmcruunJe,Clupterd.95ofthe CaliftO.
nuHealth&Sec@ryCmdc.Seetimu25505,25533"25534.IwtlrnuM .Fie Wilding
date
net currently ban a rmanl that it u my mpomibility m Emery the occupant of the
RyUne u which must be met ar MUUMUU
ssuanoo of a CeniEll of Oeeupwry.
a� n��pI��a�n� 8II�Iow Signature of Applicant Date
Owner err wrhorized agent —a All roof coverings to be Class npsr or better