05100048 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �r,,C,ONTI2A,CT, O- T�`�I ?�4R' fA7'Tq,51
BUILDING ADDRESS: REGRID POWER PERMIT NO.05100048
11497 LINDY PL
ER'S NAME: PERMIT ISSUE DATE
PETER TONG 1624 DELL AVE 5
NE: - SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHITECTIENGINEER: BURRING PERMITINFO
BLDG ELECT PLUMB MECH
619
I� 0
3 0 p LICENSED CONTRACTORS under
DE inat Of hap Job DCSCTIpn ��
I ti 1 hereby affirm that I w ONTRA CNet p DECLA AChapter 9(commencing
with Suttun70(XOaf Divitlon7aftht Business ad Professions Code.and mylice�4
e ppoH
in full forte and S GROUND MOUNTED PV ARRAY/1y
y D p�—L� �LfTECI'S O serRATION
5 `J �Y
1 un immand my plans shall he need As public near&
u
y ted
Licensed Pmfcssianal
OWNER-BUILDER DECLARATION U(/
19 y i horeby.(Aran on I arra tempt from the Contractors :My c law for enc
following mason.(Sedan 70]I.S,Buslnea and ProfeWuu Code:My oily m county
5 9 which require,a Permit m tnnamtt,shm.improve.demolish.ar repair my suumure $35000
Z'y^ prior to its issuance,elm requires;We applicant fOrmCh Fooriuo Bic a signed statement
c thathoislicensedpurauntmdaProvisionofWCCormaxwesIiceasoLaw(Coptv9 Sq.Ft,Floor Area ion
$
(comm mniniwIh Sedon7000)of DivW.3oftbo Bust..d Pmfmiou Cmde)or v'
.. Nat anen asemp,tnemfrom and We bath for the alleged••..option My violation of .
Section 703U by any applionn for a permit wbjcM the applicant to a civil penalty of r Occupancy Type
nm more title Bve hundred dollar,ISS00).
❑1,As owneroftheproperty,mmyamployw with wagesu Weir mleeompenatian,
winch Weworcm4Wotwn 4m,inundedaartmdfm,ale(Sm.704+.Baarcae Required Inspections
-
And PwIlool as Cade:The Contract License Law dose out apply m eu
an owr of q pe
property who builds m im proves thereon,and who dans such wand:himself ar tdrough his
apse employees,provided Wusuch Improvements tee not Intended uroRered fmsale.B.
however.the building or Improvement Is mid within one your ofeumplOdare.the awnr-
WiMm MB bee the burden of proving that ho did ant bWW or hotrove for pmpom of
ale.).
❑1.An wnwr of We property,w exclusively cenuuting with licensed enaumton An
counter the project(Sec.7W.Doalnm and Profesdau Cade:)The Contrectoes Li-
emse Law doe,am apply i0 an owner of praputy'w'no builds to imlaovee Wnean.and.
who conuacu for such prokeu with a contractor()licensed porsusm W We ConumtaYs
Lim.law.
❑Iarneamptunde Sea .BSPCfm W4msson
Due
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pearly of penjmy aro ofthe following dedvumns:
I love and will maintain a CenRium of Gauen W selr-ieuue forwartes'acompeo-
adon,u provided for by Section 3700 of the Labor Cade,for We part...of We
wort for which this pmnh u iarned
❑1 have and will maimain Worices Compmttatian Insurance,as required by Section
3700 of the labor Code,per the performance of the work for which Wie permit is ill wd
My WorkdT�ellan names elm"W Policy number am:
Carder: FKt7 Policy Na �4"�DaG d7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhbtcomn need ant ho completed Ethe permit 4 fmanchundred dollen($100)
or lees.)
I cosily that In Wt performance of the wart for which W4 Permit 4 Issued I shall not
employ any person In my manneran As in bremne subject W tip Workers'&Pemation
Laws of Califomic Dane
N(TMn CE ant
NOTITO APPLICANT:If,Competing n fa fauvism
of of Exemption,you nha of
become anbjas y tip WaheYo Campeoa0on Formal,
mai of the Labe Cake,you mus
.,O forthwith comply with such provisions a this permit aAJI ho domed revoked.
z► CONSTRUCTION LENDING AGENCY
f" I hereby alms the there Is a construction lending agency for tim Performance Of
C> the wart for which this permit 1.issued(Sea 3091.Civ.C.)
�W Q Londee,Name
n z lender.Address
U 0 1«rdfy that 1 have read this application end.alp than the above informed.4
U, sense 1 agree to comply with all city and county ordinmasa and MM law.milling W
0 LV: building consuvetion,and hereby authonn representatives of this city in cturupnn the
�.r til ,hove-mentioned property for Impecdon purposes.
�y93. (We)agree to ave,huhminify and keep harmless the City of Cupertino against
it cM Ilabilitip.judgmom(,cants and eapenw which may In my way acmme aganst saidCity
U in consequence of the grming of this Forth.
^"n APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date V
S CE REGULATIONS
/ o oS Re-roofs
Signature ofAypli Aale
w
_ LEMATERIALS DISCLOSURE
Type of Roof
Will the applicant or mime building occupant mon orbaralc hrurdou material
As deflned by the Cupertino Municipal Cade,Chapter 9.13.and the Health and Safety
.Section 75532(a)7All roofs shall be inspected prior to any roofing material being installed.
❑Yen &N.
Will tM appRtartt or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t It haaardnus air conumiumu an dunned by Om Bay Arca,Air Quality Management all new materials for inspection.
Dinot ct7 KIN.
pp NO
I have mad Ne hunod.rnaudals requlnmcnu mtderCMpur6.95ofthe Califor.
niaKul"SafmyCodc.Se:tiau USES.25533 sm125534.iundenun l thalfthe building
does VOL currently have a Foam the It 4 my responsihiliy W netify the=Pan,of We
req mcnuwnicnmut ipdar w af.Cwfre,Wora Signature of Applicant Date
lq
mer W authorized a Dap
All roof coverings to be Class'B"or better