08020025BUILDING DIVISION PERMIT
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HORIZON ENERGY SYSTEMS
08020025
WNEER'SiNAbMtEE:
PERMIT ISSUE DAM
P 0 BOX 320612
02/12/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)395-9060
ARCHIIECTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 l! 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hfirm ereby afdant 1 un Ostrom under provisions of Chapter 9 (commencing
with Su=n 70110)ofDivision 3aftheStd... and Professions Codd. and my license I.
PV(SOLAR—ELECTRO)GRID—TIE SYS,FLUSH MNTD,—NO
in fall tome and effect. Q Zg �) i
Liumn Class - la.g
BATTRIES
Dale Quartet r
ARCHITECTS DECLARATION
Y
1 undemand my pace Nal o need as Public records
,
Licensed Prefcuional
OWNER -BUILDER DECLARATION
I herthy affirm Nal I son exempt from the Contractors License low for the
fallowing must. (Secdon 703 1.5, Businoo and Professions Cade: Any city or county
which rtgfiras a pcmi, to cnnstract. acs. improve, dorroll t. or repair any urecum
prior to its issuance. also reform the applicant far such Permit to file aslgnW suemcm
Nat he is Contractor's Liceruc Law
Sq. Ft. Floor Area
Valuation
licensed pmuanruo the provisions ofdhe (Chapter9
h34155
S
(eammmtcing with Section 7000) of Division 3 of to Business and Professions Code) Or
that be isexempt Businessand the basis for am aleged exemption. Any Anhui on of
3 2 619 0 8 0
O
Occupancy p y 1Ype
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty ofNumber
not mom than fine hundred dollars ($5M.
.PoRN .
-
O 1, as "Words, Property, army employ= with w{asud irmic compenssdon.
Required Inspections
edoaw
sm OwJtua
Code The Contractors Law d -as rot apply lf rt owner -(
anddothewart,andtheheContunorsLt Once
am
-
who WIW orimprovea Nttran, and who d=ouch work h roffmarNrough he
enywho and
a n co serene am not intended d aroRUM for sale It.
own anPloy=, provided dant such int
however, On Wilding a cold within and liar -(completion. she owner-
U
eaimprovement
bJldtt MB love Ih burdco of proving Out he did rot ddb Or improve for purpose of
ole.).
0 I, as owns of the property, am exclusively contracting wish licensed contractors he
coastrun ac project (sec. 7044. Buinrcss and Prorusioas Code:) The Communes u-
ceass Law doe not apply to an awntt of property, who builds or bnprovea a mon, and.
who comm for such projects with a conmemr(a) licensed pursuant to the Contractors
License Law.
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caner one
WORKER'S COMPENSATION DECLARATION
1 hertby affirm under penJty o(pttjoy au of Ile following decluWom:
'
0 1 Nm and will maintain a Cmtifiou o(Coment to self-luum forWorkeh Compton.
wt., u Provided for by Section 3'ff10 of the Labor Code, for as Performance Of the
,
work for which this permit is Whom.
a NW and will maintain Workers Compensation IM1SWatQ. as rcyNed by Sud n
370D of due lobo Code, for the performance of the work for which the Permit a iaued.
My Worke`rs Compensation Tmsanmm carrier and! Policy number ane:
Carrier. _,Qp ie �.+-. —Policy No.:��
Z
CERTIFICATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
(Tbe scNon need Iutbecompkind if Our permit Is formic hundreddollan ($100)
or less.)
1 comfy thm in the performance of the work per which this Permit is issued. I shall not
employ any person in any manner so as to become subject in Oc Workers' Computation
Laws of California. Dae
Applicant
NOTICE TO APPLICANT`. If, aA., making Nu Cernfine of Exemption, you should
become subj= to the Wm ers Compensation previsions of the LAW Code, you menu
_
foNwide comply with such provisions or the permit Nall be domed remind.
CONSTRUCTION LENDING AGENCY
1 hereby affim that Neto ts a coutmcdm lending agonry for dm performance of
Ow work for which the prrmt i, tsatred (sec. 3097. Cin. C.)
.
Lenders Name
,
Lude', Address
1 certify that 1 ban read this application and sue thu ole above Information is
'
cornett I Arte to comply with all city and county omlmncos and me laws totaling to
Wilding construction, and hereby cotborirt representatives of this city to color upon the
move-mendoned properly for inspection purposes.
(We) agree m.YVe, indemnify and keep homeless the City of Cupertino agalmt
liabilities, jud{menu, costs and expenses which may In anyway erne against load City
S4(a�
A consequenceofthe UNDERSTANDS
SA permit
APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON -POINT
Issued by: Date G L
s0U CULATI
Re -roofs
Type of Roof
f De
HAZARDOUS MATERIALS DISCLOSURE
WIB Oe applicant o run= Wilding OuWmt foe or handle heuNous materia
u defined by the Cupertino Municipal Code. Chapter 9.11 and the Health and Safety
sulk, Section 25532()7
❑ Yu �No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will IW applicant or future Wilding Occupant ane cyulprmnl w devl= which
emit humrdno air coneminams u dc0ncd by Ne Bay Ams Air Quality Management
all new materials for inspection.
Dacrim7 �
❑Yes 4 No
Ihawrod the hasamfumm da]Amquimmentsunder Chaper6.95ofthc Califor-
misHulth&Se.tyCode.socdou25505,25533andZ 5M.1unWe dthulflhe Wilding
d=