04080097 CITY OF CUPERTINOs
BUILDING DIVISION PERMIT CON„TRACTaOR INF'�ORMATIIO
BUILDING ADDRESS: ECOENERGIES INC PERNITNO.04080097
OWNER'S NAME: PERMff ISSUBDATB
IR E:
SANITARY OL N0.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION Job a tl T
mF!;� 1 Wrcb affirm mat I am IkcveO un�J�er pp55qq icons n(CTapmr Y(commencing ` IAL E D
-S with don, )of Division 3 of NC Buainc4e5kProfcsaiuns Codc.and my license is
5122 Lasa Cha ss ?—CU Lie.a `12�i'3 1 SOLAR ARRAY
ARCHITECTS D6^¢.sYLiSDN OCT /1 2004
Y�.r I understand my plans shall W used as r u cords
�a6
MaLiccnnProf. onal BUILDING
OWNER-BUILDER DECLARATION
I viWnhy a1Brm Net 1 am ucmpt from IW Convaaoh IJccnse Law for IW
n O following mason.(Sachem 7031.5.Business and Proh samns Code:Any city or county
K$ which".I.a mann bs commuter,alma improve,dcmonnal.ar¢pair any structure
Fi y poor to its co esme,also sequins IW applicant farsuch permit to Rle a signed comment
gE< that he isliccreadpursuant tothe prvisimunfthe ConammlsLicense law(Chaptm9 Sq.Ft. Floor Area Valu hon
¢1–$ (commencing withSection 7000)of Division 3 of the Businasa and Professions Code)or
.. Nat W is assmpt thercftom and the baso for the a1mgW exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me altPlicanno a civil penalty Of 37VN9-N51t@r00 Occupancy Type
not mart than Fran hundred dollms($5a0L
1,as owmr of the property,or my employees with wages as their sale compensation,
will do the work and use structure is not immndW or offered for sale(Sac.7044,Business Required Inspections
and Profeolons Code:The Com
nuacf (to
s License law does t apply le an owner Of q p
property who bui Ids or im proves maroon,and who does s uch work himse If or through his
own employees,provided dtmsuch improvements art nes inen lad oro0ered for We.IL
however,me building or improvement is sold within ane year of completion.the owner.
builder will love me burden of proving that Im did nes Wild to improve for purpose of
sak.).
❑1,as owner of the progeny.am exclusively contracting with licensed contractors to
conswct IW ponjeer(Sec.7W,Business and ProfetuoM Code:)The Combination'.Li.
c..law docs not apply to an owner of property who Wilds or improves therm,and.
who contracts for such proleco with a eomncmr(s)licmucd pursuant o the COm ear's
License law.
❑I am eaemp under Sec. ,B&PC far this recon
Owner Data _
WORKER'S COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury ism of he following decluatimo:
have and will maintain a certificate or consent to aelf--insure for Worker's Compcm
ution,v provided for by Section 3700 of de labor Cade.for me Performance of the
work for which this permit is issued.
d.
have and will mainuin Worker's Compemdo
an Insurance,as n,tined by Section
3700 of the Labor Code,for me performance of the work forwhich this permit is Reed.
My Workees Compensation Insurance carrier and Policy number am:
'er` awl Polo"No.: ,Ljw D0Iyo'�I
CERTIFI ATE OF EKEMMUN FlICo RK MY
COMPENSATION INSURANCE
(This section need not Wcomplmcd Kim permit is tiro ndred unit—(SIM)
m less)
I cerefy that in be performance of me work for which this permit is issued,I shall not
employ any parson in any manner se,as to tonne.subject to he Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Ccnifcare of Emmmioa.you should
Wcome subject to the Worker's Compensation provisions of she LsWr Code.you mug
,JZ faMwith comply with such provision or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[.. 1 hereby affirm that them is a construction lending agency for be performance of
[(> he work for which this permit is issued(Sec.3097.Civ.C.)
600.Q Lender's Name �-
=Z lender's Add.
V 0 1 astify met 1 have mad this application and sage that me above information is
0 f–' corning I agree to i comply with hereby city and ceumy ntaiwrces aW state laws elating to
�C. buildin(We)as onion. .,uncaummnn representatives pbga ,be this city to enter upon the � /`•///`//p///
rW above-mentioned property for inspection purpmes. /
G (We)qac Ire eve,indemnify and keep ha,I.m IW City or Cupertino against
FN liabilides•judgmcnu,costa andeapcnws which they in any way accrue against said City
U Z In aonacquance of one granting of this permit. Date
^ APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S RC EGU TIO
�- 1 Re-roofs
Signature ofAppli VCntracaor Dem
HAZARDOU MATERIALS DISCLOSURE Type of Roof
Will mea Began or fuoe building Occupant store Or handle hvudoes material
v defined by the Cupertino Municipal Code,Chapter 9.12,and he Health and Safety
Cade,Section 25532(a)7All roofs shall be inspected prior to any roofing material being installed.
❑Yes HNu
If a roof is installed without first obtaining an inspection,I agree to remove
Will me applkmt or future Wilding Occupam use equipment or devices which
I havallous air contaminants as defined by the Bay Area Air Quality Mmagcment all new materials for inspection.
n n7
❑Yrs a
1 have text the hvaNuus materials equieatenu under Chapter 6.95 of the Cathim-
to.Hcsith&SafmyCodc.Scchmu 25505.25533 and 25534.1 tint suntl dm if he Wilding
Jars not currently haw a month that 1t Is my responsibility to nadir the M'cumat of be tl
'e uvgW met br toissuanccof.Carlos OrOccupancg Signature of Applicant Date
,I All roof coverings to be Class"B"or better
Owner r .Ilmrwd1tcnL Data