01070080 OF
NO
CI BUI DNC DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21311 MILFORD DR 01070080
OWNER'S NAME: APPLICATION SUB DATE
PETERS STEVEN 07/18/2001
PHONE: SANITARY NO. CONTROL NO.
t
O ARCHITEC MNGINEER: BUILDING PERMR INFO
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Z8m LICENSED CONTRACTOR'S DECLARATION Job Description
Thereby aRrm thaslam licensed under provisions of Chapter 9ndcry facing INSTALL SOLAR SYSTEM.
F�i-w wiin Seninn 70gj1 of Divinion3nf lM1e Bunincsz and Pmfessiom Code.and mylicable
a y, is in full force amt effegqt.�
z License Class G✓1 le Lis,N I b l
je0 Date Contractor
m 3 a Q IITECT'S DECLARATION
t a and liR my Alam shall be used az public records
as
Ear
cep Licensed Professional
e OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the
F Z Y following reason.(Section 7031.5.Business and Professions Cade:Any city or county $20000
a,€0 which requires permit to con tract,alter,improve.demolish or repair any smuctum
W 3_"pror to t on,also 9 es tire applicantf chpermnto rile asgned statement - - - - - — --- -- -
tfatihe islicensed pursd nt to the Provisions ofth Contractors License Law(Chapter 9 [ I',p�p3]i x 4 Valuation
(comme g,with Sec' 70001,fD is 1 f the Bosun,''and Pmfessions Code) t �� j ;32FSr4�l1•y /_q EALL
ser that he'is cxonpi therefrom amt the basis for the al h,ged exemption.Wny violation
of8mion 7031:5 by any applicant for x permit subjects theapplicant to n civil penalty"f not more than rise hundreddnuars(sstu). 304A1=N��` I ELECTRI Occupancy Type
01.as owns,of to property,or my employer,with wages at heir sole compcnsmim, 501 FINAL ETTECTRI At, ENERGY
—
wilydo the work,and the suacture is tan intendedorofc.d fait cale'(See 70J1:
Businesx and'Professions Curds:The Contractor's License Law does not apply to an 505 - FINAL ELMQ(IlR4 0 Aggctions'
owner of properly Who builds or improves thereon,and who ares such work himself
or through hemployees.: Provided to t himprovementst t rWW or
zT d'f 1 If how th Wu Id g P mei sold within year-ol -'- - —� - --'-
completion,the manter-budder willh the Wolm ofproving M1th did notbuild or /
improve for purpose f I ).
❑1 u n Rhe property.am ex-cl-usicaly-contra,lig with licensedconowar,to
consumer rhe poryst(Sec 7044Business and Professions Cod )fire Contractor's
Licaoe Law does not apply to an owner of property who Wilds or improves thereon, �\
.: .and.whu coated'for suchprojects aitM1 a contractor(s)licensed pursuant torhe. .
Curiosities License taw., , _
' ❑I on exempt under Sec.-' 1' .B&P C for this reason JJII f p'bJ"'i'
Date a...
WORKER'S COMPENSATION DECLARATION
° I hereby affirm under penalty of ptijury oiic of the following declarations:
❑ I have and will m,inmin'd'Cenirr me of Con.ieni w self-imme for Workds
Compensation, as, provided for by Section 3700-of-the labor Code, for the
-. peefmcnince of the..,it for which this permit is issued.-.. ,
&.I have.hd will maintain Workds Crnnpensaion Insurance,as'requirad by Section,
3700 of the Labor Cade,for the'performance of the work for which this permit is
basuirlb My
Workers Compensation Insurance comicir and Policy nb r are:
c. $1P'tiTSUNT`'Policy No 15'-[DC7 a55—DO t)�\ i .'�r,,i•r11'1F `: �ki:•j �
.'.t CERTIFICATION OF EXEMPTION FROM WORKERS''- -
..
.. . .. . .COMPENSATION INSURANCE.',` ;
"(This suction need not is,completed if the permit is for one hundred dollars
sin
($.100)or lev.l.
1 really that in the ri-formor b cc of the work for Which.tho Permit is issued,I - - ', ._j .•r!'s ` '
'shall nor employ any pe n any manner s a r cott{e s bject t the W kers y r
'Co pc ion Laws of ahforoa Dare 0"11 I l 1 O I "
Applcm
NOTICE TO APPLICANT [L'after makingth.Certificate ofExemption.you shouldi
be e.-bom
)co rhe Woke.Copeni r proon.curbs Lothar Code yo test.
Q Q
forthwith re
th c ply with such pro s or the permit h II bm
IN,deeed revoke
z'r^/� .I cr CONSTRUCTION LENDING AGENCY - n
I ab byk far wh¢I n that there to con m lending agenY f the pertamn<
ae
ofth,wor
Q Lender's Name' h iM1wpcnint s i.sued(See c 31197.Civ.C
.. ,
Z LbpdersAJJm ,`h lv. .Lr
VI certify chat l have read thio application nae rhauhe above information is
rte. cmiI Pn, ¢cu,cm..J,wlibfl city and ol)tiniy n Ili 1111111c'and'I'm Laws rclming
:0'V m building cnmuoctim,and her eby an urti icapn r.1'160 of this city to jit,ol.un'
the Oove-ngntioned property for impemion purposes.,,-
. 'Q. (Wo agree tosave:indemnify and keep harmlessrhe Ciry of Cupeninn against, r
Z) liabilities,judgments,costsand expenses which may in any way accrue egaina said
O Z^ C'ny in consequence attic ground of rhea Perri
�APPLICANT UNDERSTANDS AND WILLCOMPLY WITH ALL NON-POINY Issued by: Date
SOURCE REGULATIONS.,'' ,"•f"'"('
' S,raurc of Apprc;antaommetor " i' '�' '.p Dart Re-roofs _
t.., HAZARDOU5 MATERIALS DISCLOSURE
will the applicant or future building cocapant alae or handle haalloas material. Type of Roof. .
as illiffiredny rhe Cupertino,Municipal Cmle Ch pt 9 1'_,and the Health and Safery l 1.-:. '
�C«I' r,son 255J2( j �: ;_' L s •
oYe"" ' ', i9't_ o-,: .e',. `�' •1` •` -_ -. All roofs shall be inspected prior.to any.roofing.material.being installed.-
,WflIffic applicant ur into,.build g occ,cuot use er P i or device:which' If a roof is installed without first obtaining an inspection, I agree to remove
smith N . iT cais is mdef' d bsrite Bay AresA Q try Mani. r
O t nava all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.,
I h madme h d - te' .1ex 're is under Chapter 695 ofthe
CidifornitsHealth&Safety Cod Sections 25505 25533 and 255E4l understand that
,if the building does not currently have
coni t ih i r smy rtzponwbdny to noufy itid ��/ f./�/_
occupant of she requ remems svh ch most he mer prior to isInarm of a Certificate of
°`eupvncy1 Signature Applicant - . - _ -, _ Date .. . -
Owner or outho agent" i
�U , All roof coverings to be Class"B" or better
OFFICE