08050055 CITY OF CUPERTINOa•? 'n4x.i: '" °'` y '�'•��
BUILDING DIVISION PEPMT g 10 11 ACT0t1NF 1KM, >IONA _
BUILD DDRFSS: PERMIT NO.
i# � LILY AVE HORIZON ENERGY SYSTEMS 08050055
EBS NAME: FERMI[L4UEDATE
CHRISTOL JAMES T AND ANN E P 0 BOX 320612 05/13/2008
PHONE; SANITARY NO. CONTROL NO.
(408) 395-9060
ARCHrIELTIENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION I IOb Description
F i hembm decideddecidedd
y am.Wt I amade,provisions of Chapms 9(commencing p
wtthm
Stkm70 I)o(Divid° SOLAR HOT WATER SYSTEM ROOF MOUNTED—PAINT
^�H is fall force cede act
�pz Uenmelas 46 Lte.0 if FLASHING
Dam rj oduma nr 4k,'r }nI .•.'moi
ARcHrIELTS DECLARATION r_Np�7 TRIM TO MATCH ROOF COLOR.
��� I underaunJ my plw Mol bo uud v Public rtcortls .
a
yQt; Licensed Pmfevionel
or 3 Oat I am exempt
from
DECLARATION
Contractor's
ZOOO E I looby.(Sero that 11. excmpl from the CnninsW o Licenseyc Law for she
p O following mire^n.(Saito 7M 1.5.Business and Pm(nsdans Cal: pa WIY m County
which rtquuns•Permit w canpmca alar,im for such
h permit or mash ed aVu°Wm
PrfaWiucensede.aluantto rca thovisios o for mchpetor's music Law(Chapter
ppxx Wloncrci gwithSrsuantmth)ofDivisiuo oftheBlsinessanimnsclaw(C ode)mr Sq.Ft. Floor Area Valuation
YI-9 kat W is exemiNSmfourn rom and
Anand y
iCade)m 5875
..
that io u campy Ommfmm and or.Eva for W alleged theumptlthi Any violation of
has. 7Who byatryleddenafmapermitethjttuWappliontmadvilpwbyor Number Occupancy Type
ml more doer five hundred doliasa(SSW). 35903008!�� P Y YP
❑1.as ownes of tife property,or my employees wish wages as Neu ml comPenadm,
will do she work and she momitire Isnot Waded or offered for sem(Sec,]Oat,Buri.
w Professions Cc&The Cenuacterm la
s License dam Out appy m an moven of Required Inspections
Property who Wilde orimprom Wmon.and who does such work himsel(ur through his
mwemployw.psavldd that such impmvemenu art oro inmdd atQemd(msalu R.
however,she WiWing m impmvemem is sWd wishin one yvr:(completion.W twoer-
Wilder NR low W Wren of prtving that M did mt W W a improve for pmpou of
sale.).
❑1.as caner of the properly me exclusively c°nlracaing wish limned Contractors to
construct W pmjem(Sm.7044.Business and promotions Code:)M Coatraemrs U-
cove Law does sea apply to an owner nf property wider Wilds or improves thereon,and,
wbocmtacu for such pmjeN with a cmaractre(s)licensed pussvm W the Conmclors
Lice.Law.
❑I sec eaempr under Sec. ,B k P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
1 hemby afford under penally of perjury one of W following declardons:
❑1 haw ad NI munuin aCutifiCota of Coven w calf-insuu(a Workers Campem '
avian, pmvidfptSectio 3]W of Ne Labor Cade.fm W prsformanCo of the
ante forr which than pmmrm ia is issued.
el 1 have,and will maintain Workers eompensadon Insurame.as mgwd by Section
31ODathe Labor Code,for the pmfonaanm of tho work fm which this prrmil is issued. '
My Widk zCompewdon Wsueatae cargos and Policy number tie:
carrier. 4-
- Y.-.-rX Polfry Ne.: Sed( 7133 '
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(TMs udon acted mabe completed if the petted Is fa°ne hundredduRara(SIM)
Or Icsa)
1 snarly that in she performance of the work for which this permit is issued.I shall not
employ any penin in any mumerso as in Mame subject to the Wodzd Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:It.after making this CcNfirate of Exemption,you should
become subject m W Winters Compensation provisions of the labor Code,year roup
.J O fanhw•ith Comply with such provisions m this permit shall bo deemro
ed oked.
ti" CONSTRUCTION LENDING AGENCY .�
I Wmby affim that Vert is a construction Lectin a for tiro
Lending Gem]' perfarmanCo W
C�
the,dndrtfor which dds permit is issued(Sa.3Wy.Civ,C.)
ILl Q Inndes's Name
n0.7 z LeAdd
nder:Mdmss
U O 1 cenffy that I have rod this Wined.ad stem this the above information u
D.E coma I agria m comply with all city and count'°Ninvxes and m¢lows misting to
O (i.^! Wilding c°npruoion.and hereby authonm upresenutivea of this cityto coot upon da
above-mentioned property for Wspecdon.which may
F y (We)ague m save,indemnify and keep harmhxs the City of Cupmtim aguma
i,iZ IiWilideedence Of
gr uand anting Ofperuu which may in any wayamoeaguvysald City
U Z APPLnal nCo of DfASTAN of s parourit.
ND WWILL OM Y TH ALL NON-POINT Issued by: Date
SOU ULATIONS.
S f 3 Re-roofs
Signuma of ApplicanUCanuamur Data `_--
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupant same or handl hvutlom mannod
v de0oed by de Copenitm Municipal Cade,Chapter 9.12,and the Health and Safety
.claim ssslxfa)" All roofs shall be inspected prior to any roofing material being installed.
❑Yat ❑No
Will W applicant or rumrt Wilding oavpant own equipment or devisns which If a roof is installed without first obtaining an inspection,I agree to remove
emit hu-nems tar conummm s v defined by W Bay Area Air Quality Mansgemenl all new materials for inspection.
D oricR
❑Yes ONu
I have and W hamrdess mam ials requirements under Chapter6.95 ufthe Califor.
his Health&SafclYCade.Smvau 25505,B533 tray x5531.1 undrmad that Jthe Wilding
dors net emocrigyh.ve a unto l It u my s mibilily dry the occupant of Nc
regnirt nmpuboTmetpriamfvapens
° c atom Signature of Applicant Date
oermauthonsedagcnt Da All roof coverings to be Class'%¢"or better