03090077 CITY OF CUPERTINO ra+ � � r�,i>� .agrx,.• �gy:
BUILDING DIVISION PERMIT ?CONTRA ATQkJNTORMATIJO �
BUILDING ADDRESS: AKEENA SOLAR PERMITN63090077
OWNER' NAME: 13991 PIKE RD PERMT ISSUE DATE
E:
(408) 867-0558 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELEL7 PLUMB MECH
0 0 0
10 Z, LICENSED CONTRAC`rOR'S DECLARATION
1 hereby affirm that 1 am licensed under pmvisioni of Chapter 9(commencing Job DCSCTIpt100
nIn�zl� with 5cc'a tcttaap((o��f pyyiviaio��n]yyof��N�e Businappnd Profcssinm C.-dc-..nd my licnse,
j,a�Z Licoo to
aei�"�dre» Ic.✓_ ROOF MOUNTED PHOTOVOLTAICS
=^p Dam Canlac
ARCHITECTS DIiEeARATION
i F•
fid..ta h aadap.hit.record, SEP 2 3 2003
eo Licensed P�r�tlruf nikj in — —7
OWNER.BUILDER DECLARATION BUILDING
<Y 1 hereby affirm that 1 am exempt from Nmmnots e CaLicense Law for the
w 0 following reason,(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alma improve,demolish,or repair any structure
3y< prior to its issuance.also requires the applicant for such permit o rile a signed statement
¢s that he is Norrosed pursuant to the provisions(if the Contractor's Liucnm Law(Chapter 9 Sq. Ft. Floor Area Valuation
c+t-re (commencing with Section 7")of Division J of the Business and Professions Code)or
$ that he is exempt therefrom and the basis for the alleged e,emption.Any violation of 32619081 . 00
_- Section 7031.5 by any applicant for a permit subjects the applies at to a civil Penalty of APN Number Occupancy
not more Nan five hundred done..(5500). "-' ' - ' p y Type.-
-----
I,as owner of the propcny,or my cmployces with wages as Nes sole compensation.
will do the work,and the structum is not intended or offered for sale(Sec.70aq Business
and Prior Code:The Contrto cup's License law docs nut apply an owner of ODS
ions
pmpenywhe builds or improv thereon.and who dosssuch work himself.,through his 501 - FINAL EL CTRI 'AL ENERGY
own employees,provided that such improvements are not intended oroffened for mileIf. 505 - FINAL ELECTRICAL
however,the building or improvement is sold within one year ofcompledon,the owned _ . .
builder will have the burden of moving that he did not build or impove for purpose of
sale.).
1,a owner of Ne property,am exclusively convecting with licensed contractors t. - -
consumer Ne pmjmt(Sec.70C .Business and Profusi.ns Code:)The Convector's U.
come Law docs not apply to an owner of pommy who builds or improves thereon,and
who contracts for such projects with o contractor(s)licensed pursuant m the Contractors
License Lew.
❑I am escono under See. ,B&P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Xna ty of perjury one of the fallowing Jeclaraii.m:
and will maintain a Cenificae of Consent to self-insum for Wormes Compre
e
un ea Provided for by Section 7700 of Ne labor Code,for Ne performance of the _
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance.as required by Section
37W of the Labor Code,for the performance of the work for which this permit is issued, .
My Woher'v nm motion)surenc�c..carr�'f'r and her art:
C brNAPalicy
CERTIFI CATE OMPENSATION
FROM WORKERS'
COMPENSATION INSURANCE
This section need nm hccnmpleted if the Permit is Intone hundred dollars(SIM)
Icss)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner sn a se become subjects.the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
hecome subject to the Worker's Compensation provisions of the Lehr Code,you must
O fonhwi in comply with such provisions cr m
this perit shall k deemed revoked.
Z N
CONSTRUCTION LENDING AGENCY
1 hereby a(fvm that shore its construction lending agency for Ile perfmmance ser
]' the work for which this permit is issued(See.3W7,Co.C.)
AUmder'a Nam.
z Under'sAddress
1 certify Nat I have read this application and slate that Ne above information is j
1. (✓ correct.1 agree to comply with all city and county ordinances and sum laws Misting to
J U building construction,and hereby autharim rcprmenatises of this city to enter upon lha
C above-mentioned property for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City of Cipenino againat /
rat liabilikolujudgmenu,costs and expenses which may in anyway accrue against aid City
J in conaequemc of the granting o this permit. 1
APPLICANT D AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale l
SO(}RCE R� ,IO ) v,
Re-roofs
Siarc ApP cant/ n Date
HAZARDOUS MATERIALS ding..pa DISCLOSURE Type of Roof
Will theapplicantlar(Muni buildings,Char ,9.1 or handle hazardousd Saety
a defined by the Cupertino Municipal Cotler Chapmr 9.12,and the Hcahh end Safety
CoJc,Section 35532(a)?
❑Yes ` % All roofs shall be inspected prior to any roofing material being installed.
'
Will the appfica t or Tamm building oecnPant a eq poem oraema,which If a roof is installed without first obtaining an inspection, I agree to remove
omNbus air contaminants a deRoul by,the Bay Arca Air Quality Management all new materials for inspection.
cot?
❑Ycs
1 have mad one harardnus mahorialsoquiremen.s under Chapter 6.95 atom Califor-
niaHealth&SafnyC c,SnuomMN#,25533 and 35534,1 orders"this ifthe Wilding
doe.not curmoly hg aaanaalr u my responsibility,m paddy the aeupant of the
requiremcrosov'm i s cm prior lsk ran,car.Cerificl aroceapane. Signature of Applicant Date
own as naso a nI A m� 03 All roof coverings to be Class"B" or better