01030140 cl TY G DNo
DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: _ PERMIT NO.
10205 JUDYAVCUPERTINO PLUMBING 01030140
OWNIiR'SNAMIl - - APPLICATION SUB DATE
1 1.0297• S DE ANZA BLV 03/25/,2tD0'1
T PHONE: SANITARY NO, CONTROL NO,
J J
(408) 2133-0619, -
Mal
406) 293-0519Oa Z ARCHITECDF.NGINHER: - _ ` BUILDING PERMIT INFO
�o O O - - BLDG ELECT PLUMB MECH
1 ICI NSI P CONTRACTOR S DI(I ARATION
z z d I n ny mf un .. t.uco ,eJ f r ren mer9 aomn e ,g .• Job Description
wit section Woan or D' aon3.1 the Br mi Nea,ion,Cove,and my
lxeme
6 is int Il f deffect. .
�oLaver cite, a WATER , SERVICE',
c. nine C . t r
w S
0 ARCHITECT`S DECLARATION
O S 1 understand in,plan.,shall he used as.on Mile broad,
a p O 'Licaiscd Pmfecsimal -
3 0�y OWNI It BUILDER DECLARATION
ARATION
u7 I h rchy fl moll rl l n'he Contral Licenw,Lave In due.
CLQ Illi I,muou,(Section 7031.5.Buourt,andPour,onums Cof Any city fir cut ty
E A 0 which requires a vannit lconstrict, 1. p J m r b r repair any doncLum
ce
3 poo . n ance I. rcyu .the apPOc m f ch M1 i n Ile s gn L mmmem
fhathe is licensedrental I the provisionsofinec tura t r LmvalLa (Clep.ay Sq. Ft. Floor Area ,Valuation'
Iro mencmg wnh Section 10001 of Division 1,111h,the Ifuancsv and Nor.voo,GNel
or that he is exempt therefrom and the basis for the alleged exemption.Any viola.inm $-600
of Section 7031.5 by any applicam fv a .it subjects lite loo civil far ally
,if am mom man five M1andrcd Jouam(S500). - APN Number ';Occupancy Type
rJHIrvovmo7offf.pmsedyo, oycoadofeelvolfivoll fall,vole c are n'nn . .
will di work, ,,fit lue o . 11 l - Bred in ofle(Ser.]IWi,
Rusionva andProfessions Codi I lie Common's L Law,does not applytoan, -Required Inspection's
firour of p..Perry Wife Illimprover h son,and who does such work himself
or through his own nnployees.provided that such in.pmverram s arc not intended or 105 — SEWER & WATER
I nMust for sole.If,homelier, he building or imprevemenl is mfr'within ane year or
Completion.the menervlwilder will havethe buNenofpmvingthat hedid not builder 202 — UNDERFLOOR- PLUMBING
improve forpurpose or sale.).` I -
❑I.avowneroftheproprty,nor.0 ,ieelyronfmctingwghfcensedcommnorsm 301 ROUGH-. PLUMBING•
i.mx.mm me im,iee.(Ser,nu4,Ba,me„amt Pr tc,stan,Cade:)'rhe(.....term", ' i 130❑^. TUB ,&& OR SHOWER '
icel.,eLa.lee,m�ligiply le tin mwna,ofpmpony who Wild,or imrnom,luron, s _ _
anal❑lawhoxemplctsforevncll a - - ,502, -FINAL -:-ENERGY
Commcmr',Li¢ns8 Law. "tams With a conrumorlq licensed pununm In mo e
under
&P C for thin manna • '506 — GAS TEST
Owner Date • ' '504 — 'FINAL;-,PLUMBING,,. _
WORKER'S COMPENSATION DIT
C1.ARATION -
`�, I hereby affirm under pal d perjury.,or ofthe fnllowing deelarulno: "
/ s
I have unit will archado i Crnrcaaa of Cf cat if, d for Worker',
-
Cm p cmationt: ....... I I to, by Sell 1 .1700 f II I aM r Code, f -
mel ,I of the .kr whchlhtsr 11xi:,sa 1
,
❑I have and will maintain Worker s Coaramentinan lasumare,us required by Section
3700of the Lahur Code.for the performance ml the work for which this pert I, /
issued,My Worker's ComPensaion Insurance carrier and Policy mode re:
• .Cam Poll,N
CFRTII ICAI'ION(31 XE 'ION ITROM NOIiKPRS -
COMPENSATIONINSURANCII /
T
_ ('O,.scr'u.nsnl til by aunPlcfedit Ilia pc 'I 1,lnone M1u Wrc IJnlLlrs
.I cer ify that in the pelonnanre or the work fur which this permit is isated.1
shall not employ any penun in any manner so as fit Mcnme subject o the Workers
Cnmpcnsmiun Laws of Celifomia.Dae -
NOTICETOAPPLICANT:If,aper making avis Certificate of Exemption,you should
henn.e subject to Workers Compensation provisions of m
the Labor Code,you us. _
O p o nhwnh comply with ocn lowil,ion,or mi,mn.df tlmll Is,dremad n„oked.
.� � CONS emUta IONcons LENDING inAGENCY
Ih by ❑ InIlia[ l period
n edsee. lending for(he lx 9n nanco -
LTj of the work fon which.bs Puma Is issued see.",IY)].Civ C.) _
0. Q Linder•,Name
� z Lender's Address ss
V 0 (certify that l have mad This application and state that the above information is
s. p cmmct.1.,me In comply with all city and coulrt,ordinances and some law,relamg '
O Vm buildingerfromcfioo,and hembyouthoriurcpresenta.ivesnf.his city m,awridon
ry .hc ahnvm
aemim,ed prom
pcny f r spemimt pumas(,. - -
��yy Aa (We)irms: 'fy antiA pl I ,IIIc City of Cupertino uI
Ir Ln hublltl md,amao.c I 1 a,ca,8 whodi onlyin ily way amrue ugul n..aid • „
V City'n co.,,nerecol filegranhngof Ih,peril...
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINrY• Date
-Issuedb
SOURCE REGULATIONS. ,
Signamm or ApplicanVCurtmetor Dam- RC-rOOfs r
HAZARDOUS MATERIALS DISCLOSURE
Will the appfeav or fmnm building occupona.mc to handle haurdoue material 'Type of Roof .
a,d,incd by the Cool Municipal code,Chapher 9.12,andme Health and Safety
Cotla,see.ion 25532(a)!
❑Yoe n No All roofs shall be inspected prior to any roofiing'tna[erial being ainstalled.-
will hearpfenno,Rome bmidIingnrcnrm'tale nitdmmentnrdevices.1o0i If a roof is installed without first obtaining an inspection, I arra ' io.remove
�nnit h...im ,iturnnmminunu a,Jefinud by fbc Buy Arca Air Quulil,Momr,coem g P b
D . t all new materials for inspection. Applicant understands and will comply with
`f> oYcs No all hon-point Source regulations.
I have read the h larJous materials rcgnimmcnls trader Chapter 6.95 of the -
CulifnmiaHeallh&Solely Craft,Sections 25505.25333and 25534.1 understand that - -
if the padding does no.curndy hmc a moan.,mail is my rcspomibility m notify me
' x'cupant of the reyuimnlcuov which Ina,.Ne met print In issuance of a CenlBeae of '
r ()cu,nou". .
< Signature of Applicant ' � Date
Data
1 All roof cover6'
in s to be Class "B"or better
Owner or amhorirrl ngcm -
-
OFFICE
CITY OF CUPERTINO - ' w
BUILDING DIVISION PERMIT CONTRACTOR' I'NFORMATIO,N:.
BUILDING ADDRESS: PERMIT NO.
10362 JUDY AVE MC SOLAR ENGINEERING 01100140
OWNER'S NAME: APPLICATION SUB DATE
MARY RABY 1168 ASTER AVE 10/26/2001
HONE: SANITARY NO. CONTROL NO.
(408) 261-1211
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m u BLDG ELECT PLUMB MECH
y a i` I---t ICJ L--.J L=1
U w i LICENSED CONTRACTOR'S DECLARATION Job Description
j Z_C 1 hereby affirm,hat l am licensed under provisiunz of Chapm
mt 9lcomencing
mCua
aid,Section]I1f10)ofDivisiontof,heBusinessandPmfcssiamCede,andmyliccnse INSTALL PHOTOVOLTAIC SYSTEM ON ROOF.
i0a, is to eat rr (4KW)
=s ¢ License Class Lic.M I
3 LL h Dae Commeor ..
AR ITECf'S DECLARATION
;n O n 1 undeommd my Alam sholl be used as public meords
:�T
i app Licensed Professional
'K oOWNER-BUILDER DECLARATION
Lo- 1 hereby affirm Ima 1 ore exempt from the Commetm's License Law for the
c-Z following reason.(Section 7031.5.Business and Professions Code:Any city or county
S C
which requires pemn,10 construct,alter,improve,demolish,Or repair any surramm
�a3 prior toits uvanc Iw q theapplicant for such perm,to file asgned nam eat - --
that h Ian it p .-tio to the pro t ions of the Contmaolss and Pr Lew ons(Chapter) ,, , Sq. Ft. Floor Area •, al III ion
(commencing with Sea ]ouundfDivisionsisfor hehe
savf Profusions Code) 1 IL l ) s�tw st.•n•r,J - _sA2 f.Yp
or Natio is exempt zany a ore and,he basis for the alleged exemption.Any l Penalty-of Sof.,a firan ix any applicant for a panni,subjects the applicant to a civil penalty"
rornamnretnane�ehpmreaamlmasW). umber 11 c.tn :n Occupancy Type
❑I,as owner of the propcny,or my employees with wages as,licit sole compemn,ion,
wilt do the xmlk,and the nrunum'is not intended or oRerctl for sale(Sec:70N4,
6usineis'add Professions Code:The Contractor's License Law docs no,apply,o an 501 - FINAL EEffM"1QA49tiQWERGY
owner of property Who builds of improves thereon,sad who does such work himself
or through his own employees.provided that such improvements are no,intended or _ _ ___505 — FINAL ELECTRICAL
CAL
-.1ficinid fie_aide If Roxclier,'fine buildi.for improvioncon is sold wIlhin one year of "
completion,Ne owner budder will have the burden of -
p Prov ng that he did not build or
imp f p rrysu of sale). ,
_ .. _... m _ _ . .
❑1tr c projfilmect
property,am exclusivelyinessconunammer,Ce licensedcontractorsComtomto - - rt •s t: .construct due the pm)ec,Iaptl ]844,Owners property
ro Profession Cade.)The Convenor's :er., •o.,
+- License law does no,apply,o an owner of pro ormawho builds or improves theeam
` and.who.mnoacu.forsuch.projttu.with.a commnorts7.licensed.pomumt,a.Ne Jh
Conem exempt
License Law.,i ,y_ __7..9ao2..
❑lore exempt ander Sec. _ „" ' - B&PCfm Nis massa Cyt•''qty;Cgk drP'i U`tt
- - Owner_... . ..tt-. : ➢sat BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby arftrm under fanhy,of perjury one of,he following dechm,ims:
I have and will maintain a Catifcatc of Consent ,o self-mom for Worker's
Compensation, as provided for by Section 37W of the labor Code. for Ne �'����
performance of the work for which this peoni,is issuack
f. O 1 have and will maintain Worker's Compensation Insurance,as required by Section
AW of th labor Code for the performance of the work flat which,l,jt.-pe,mnn
ism d My W rkers n e,rfllum artier adn4P /IryV aar'bsD�IgJQ
" Carer .)4,aPoliyN /'`D" as ' � IIU IID'D
t
fill OF EXEMPTION Mt WORKERS �!j•-. 1 [ ' d A 1 a n'.: F 1 5. . . y.:
COMPENSATION INSURANCE', - "---BUIL-DING. .:-- ,:• ��
' 'I (Dai sceuon need not be completed if Penni,is for one hmMfcA dollars s•X14 ..I l t t . t l a.l.P,.1,0
($1 Wl or lers.)
1 car fy that in-ere pc ny ma of the ark wh
for ich Parra issued 1
shallemployI�; ' a s .;i('1" •_. _
t -ny pc in any manna m
es t NWorkers'Workers'CoCompensation laws of Califomia.'De!e NOTICE comesubject
O APPLICANT:If,afterpenki tion pr provisions
n s of of Ltbar Car.younym muld
st
become subject y the such ors Compensation provisions f I the labor Code:you man
Z Q f- ---comply with such provisions o- his permit shell be deemed revoked.
. _ _ . t-Bl l:
= ' CONSTRUCTION LENDING�AGENCY"' � "' � ----- -_ -
s
' _I h"ieby affirm that them is i eonsihtc,ion Ietding agency for the performance „ t
of the work(or x hich this permit is issued(Sec.3097.Civ.C.)
L
lendar'e Address:
Ot, Will,
I cenify that 1 have rcad this application and stam,ha,,he above information is
a6mot.I agree to comply with all city and comity ordinances and state laws relning
D V to building con fa"
and hereby amhodu repeesenmtives of this city to enter used
,. k] theabme-men,ibned property for.inspection parpous.
r_M. (W,)agree idowc;indcmnify and keep hmmless,he City or Cupertino against
V) liabilities,judgmcros,costs and expenses which may in any way,accoq against said
City in con semarim ofttie gmming of adds'Permit
.
_ APPLICANT UNDERTANDS AND WILL COMPLY,WiTHAlfC NON:POINT'"
OURC�'RF ULA S'S. "' ) "' Issued by: Date
ign, of li nmiacm . " - .. - '. D.a Re-roofs _ m
• HAZARDOUS MATERIALS DISCLOSURE' -]
Will a applieln,or future building occupant atom or handle ha=umns rnur al Type of.Roof . .., (._ .._..._._.... _
as defined by,he Cupertino Municipal Code Chap, 9 I2 and the Health and Safety }p t '- " . `,
Cbde SpYs 255321a) k I ON \ �� ..r �1 i I s 1 71'V.a1Y rt J'3 i: �'i{.�':. s; is
k r•' All roofs shall be.mspected prior.to.any-roofing material.being.ihstalled. -. .._
Wham Iffoicogratn far.budEing eripar,a.toluipmarm or dashms.hich If a roof is installedwithout first obtainingan ins ection',,I agree to'remove
�oth harardoas av contamtnanss res defined by he Ray A.Air Quality Management p g
iaN tl .
r oyes ❑No `all no mate ials.for ins ction, e _'_ __ p y
all new r pe Applicant understands and will cam I with
' non-point source regulations:.
1 ha e re d Ne.harardousme,edals rcgmrcmen¢uncle Chapter 6.95 aide Califomu NeaIN&Safety Coda Seniors 25505x25533 and 25534:I undmtand,ha
f the bu0d'n8 doe not currently have a reno.,-,h t i,a my icspon b Itai to no,ify,he -- - '" - -"' '-"' - - — - - _-_ _.
acnipant of Ne req ire is hich most
he mei poo m Issas, o a Cmince a of
r
an
sy' ..
,�j Signature_of Applicant_ Date
G ornn0ta igen, ;,,Data All roof coverings to be Class "B"or better
- r
- . . OFFICE