07120214 CITY OF CUPEWFINO
BUILDING DIVISION PERMIT .£Ci)N. T12AClTl �OR INFORMATION :
BUILDESS: PERMMNO.
TbD g3 HILLCREST RD AKEENA SOLAR, INC 07120214
OWNER'S NAME: FERMTT C35UE DATE
GRACE KING 16005 LOS GATOS BLVD 01/04/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 867-0558
Hr1EC7MNGINEER: BUILDING PERMTTINFO
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION lob Description
u Fj1 hereby affirm that I am licensed under provisions of Chapter 9(commuring
with Secti.n7aw)of Division 3 of de Business arld Pinfessmad Code.and my license is INSTL 24 ROOF MOUNTD PU SOLAR MODULES
in full forte and eBcet
Licence CIy, Lk.N
it- Deo ! ,a CECr
q ARCHTIECTS SDDECLAR C N
i$� I understand my plans shall he used as public rtenrJs
:.0
o G Lie and Pmfcssional
3 OWNER-BUILDER DECLARATION
I I hereby affirm that I am eeempt from the Contractors License Law for the
:p O following mason.(Section 7031.5,Business and Professions Code:Any city or county
e S 2. which requires a Permit to convect,elect improve,demolish,or repair any structure
prior to its issuance.also requires the applicant for such Permit In File a signed moment
out he is licensed pusauanuo she previsions of the Conidere's License Law(Climber 9 Sq.Ft. Floor Area Valuation
kms$ oat he sc osimpt Sxtion7000oe basis for of thengedexeand Professions Code)or
$26592
Natio a exempt therefrom and the boa for be alleged exemption.Any violation of
Section 7031.5 by any
undredapplicant fon Permit subjects the epplkanuoadvil penalty of M�V7 Number Occupancy Type
not mart Nan five hundred dation(5500). 3 2 616 0 5 2 . UU
❑I.u owner of ft pmpeny,m my employees withwags u theb mk cmmpeuadon,
will doth,worlemd themucuum isnminknded or offered formic(Sm.7044,Bmittess Required Inspections
and PrOf,ylmla Cade:The Comacbrs Uk Law tinea.1 apply m N owner, ns a( q P
Impurity who builds orimprow o;Nemon,and who doessuchworkhimalforthrough his
ownemployew,provided Nn such impmvemenu arc not intended oraBered forsale.If.
however,the building or improvement is mid within one year of completion.the owner.
builder will have Ne hurden of pmvtng that he did not build or improve for purpose of
sok.).
I.u owner of alas property...exclusively emir actin,with Incnced xntracsmt be
construct the project(Sec.7614.Business and Profeasiou Cade:)The Conuaebfa U.
come Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a eomractor(s)Removed pursuant in the Contractors
License"or
O lamaempaundersee .B&PC Torahs moon
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the fallowing declaratiau:
ja I haw and will maintain a Certifiroo orconsenl to self-imem,for wmkcrs Cranium.
Mu,u Provided for by Section 3700 of the Labor Code,for the performnm of the
far which this Permit is issued.
I have and will maintain WoiRers Compensation insurance,as Occulted by Section
3700 of the labor Codd,for thd Performance of the work for which this permit or issued. '
My Workers Compensation Women,artrt
carrier and Policy number e: ,
Carrier.S♦w'ies f Un.O Policy No.: y3--9OC
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(TTls section mad not canplcecd if the Permit is for one hundred di ($100)
or less)
I county thvt in Ne Performance of de work for which this Permit is issued.)shall not
employ my pe.0 in any roannerm ss in became subject to the WorkersCmepensa0on
Laws of Calific.m Date
Applicant
NOTICE TO APPLICANT:If..But making this Certificate of Exemption,you should
become subject in the Worker's Compensation provisions of the Lm r Code.you mum
.J O forthwith comply with such provisions or this Permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
E•' Iherehya0lrm that them iso construction lendingagency fur the perfmmseouf
C4 7 the work fur which this permit is issued(Sec.3097,Civ.C.)
W 0 Lcodcrs Name
0,z Lender's Address
U I certify that I ban mad this application and then Nn the above information is
Fcouect-1 agree in comply with all city and county ordinances and sure laws relating to
0U building consbmcfln.md hereby mo.n.rcp.nu.dws.r this city,.enter upon the
� 44 shove-memiuned preper,y for inspection purposes.
CL (We)agree wean.indemnify and keep hamdess the City of Cupertino against
rFi IA Iisbfthics,judgmenu,cosu and expenses which may in any way acerae againstsaid City
U Z in consequence of the granting of this Permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: Date
SOURCE REGULATIONS.
d4A-1/VliVta/ a /305( Re-roofs
Signatu o Applicam/Conlramor
HAZARDOUS MATERIALS DISCLOSURE ere Type of Roof
WIB the applicant or future building orcupanamo a or huddle harardues material
as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code.Section 75533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Pff.
W
ill do applicant or future beading occupant use equipment adevices which If a roof is installed without first obtaining an inspection,I agree to remove
rdous air conuminmu ss dcftncd by the Bay Ana Air Quality Management all new materials for inspection.
Yes i[(Nu
have mad the havaNrnsmamdals reqimmenuunddrChmse,6.95oftbe Califor-
Scemes 25505,25533 and25534.1 undenhend thatifthe buildingemmuly hawse a temn4 that it is my responsibility w notify the oxupmt or the
emawhichmu,tbemetPriortoiheumxof.Certifmine0 mp.acy. Signature of Applicant Date
ramnodred ascm pace O All roof coverings to be Class nBo Or better