02100141 CITY OF CUPF.RTINO -
BUILDING DIVISION PERMIT ''CONTRACTOR INFORMATION:
BUI prq(3aiPlnROAK MEADOW CT ECOENERGIES INC PERMI'rN®2100141
ARNOLD DELEON 171 COMMERCIAL ST APPLICATITIt�iYIT6TIY 2002
PHONE: (408) 746-3062 SANITARY NO.// 11 �� CONMOLNO,
ARCHITECbENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
wpp LICENSEDCONRACI'OR'S UECLARAI[ON p
�F I hereby affnn at l am licensed under Pmvisiamor Chapter 9(cummcncing SOLAR PANEL S���EMcription
U with Section 700(b.]Division J of the Busines d Prnlexsinns Cude.nd my license is
w in lull fo¢'c pqod Tice q.
oi�o peense Clurtz �L'`(''E Nl Con live3 / G'�yb 76r9��®
F=�� 11 ARCHITECT'SZ. Al ON
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x221 Iundecsondenyplanss.11he sedan Niewcords DEC 13 2002
�dD
w 3 u Licensed Prolcainnel
F U O 1 OWNER-BUILDER DECLARATION
uun�<p 1 hereby affirm that 1 am exempt from me Cono,cmds License Law for the $59318
w6p0 billowing reason.(Section Business and Professions Cnde:Anyed,oreoumy BUILDING
O.n$fl�. which requires a permit m construct.alter,improve.demolish.or repair any xoucwre
rZa priorm its isuadee,also requires the applicant for such permit n file a signed statement
�ySS that he is licensed pursuant to the provisions of the Contractor's License law(Chapter9 .'�6l2.ff0c9)8Arl Valuation
aF$ (commencing with Section700(hof Division]of the Ruxiness and Prol'esxidns Code)or
a 3—
that he is exempt therefrom and the bole for the alleged exemption.Any violation of
Section 7031.5 by any applicant fur,permit subjects the applicant o a civil penaltyof pNrN Occupancy Type
not more than five hundred dollars(M). 102 — PIERS
1,as owner of Ne property,or my employees with wages as their sole compensation,
will do the work,and the suomure is not intended or offered for sale(See.)814,Busince;
and Professions Code:The Contractor's License Law dura not apply m an owner of 104 - REBAR Required Inspections
property who builds or improves thereon,and whodoes such work himselfor through his
own employees,provided that such improvements are not intended or offered for sale.If. 105 — ANCHOR BOLTS
however,the building or improvement is sold within one year of completion.the owner- 106 — SEWER & WATER
builder will have the burden of proving that he did not Wild or improve for purpose of
a1c.) 202 - UNDERFLOOR PLUMBING
❑Las an,of the propert,am eacwaivey convening with licensed contractors m 203 — UNDERFLOOR MECHANICAL
conswn the project(Sec.7(W4.Business and Pmfeesions Code:)The Co onnam's Li.
Law does not appy es to an Owner of property who Wilds or improvthereon.and 204 - UNDERFLOOR FRAME
whse o contracts for such projects with a contrannrod licensed pursuant to the Comaeton 205 — UNDERFLOOR INSULATION
License law.
01 am exempt under Sec. .B&P C for this reason 301 - ROUGH PLUMBING
Date302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 — ROUGH MECHANICAL
Ihereby alrm,under Penalty ofprymyone ofthe following declarations: 304 — ROUGH ELECTRICAL
I have and will maintain aCenificaten(Cdnsenuoself mom for Worker's Comprm 3O5 — FRAME
cation,u provided for by Section J]IM)of the labor Code,for the pertosmancc of the
worknvwhichthispermnisissued. 306 — HOLDOWNS
C 1 have and will maintain Worker's Compensation Insurance,u required by Second 307 - INSULATION
3700 of the labor Cole,for Ne peRormane,of the work for which this permit is issued.
My WorkeJ's Compensation lnxunnce carrier anJ Policy npSuWr 308 — $HEETROCK
c,nirr:LumiSfRN v' ''MMyy��yyyy G 7�0 309 - EXTERIOR LATH
CF:RTITICATE OF F,XEMPI'IROM WORKERS' 310 — INTERIOR LATH
COMPENSATION INSURANCE
(Thisseninn need not he completed if the permit is for one hundred dollars($1 did 311 - SCRATCH COAT
unless) 313 - ROOF NAIL
I cenify that in the Perfonnaner of the work for which this permit is issued.1 shall not 501 - FINAL ELECTRICAL ENERGY
employ any pe veno in any manner m as m become subject n the Workers'Compensation
Laws ofcmiforma.Date 502 — FINAL PLUMBING ENERGY
Applicant
NOTICE TO APPLICAN`PIl.after making this Cenilicale or Exemption.you should 503 — FINAL MECHANICAL ENERGY
beemare,ii1mbreL to the Worker's Compensation provisions(it the Labor CWc.you must 504 - FINAL BUILDING ENERGY
O Z forthwith comply with such provisions Or this permit shell he deemed reached. —
O 505 FINAL ELECTRICAL
z .yN. CON.S0NLENDINGAGENCY —
(r Ihcrcnyalnrmthmthcncis acon.Nmninnlending agency mnWPcrformanceof 506 GAS TEST
FL > the work far which this Nsmitisissued(Sec.NAG,CmC.) 507 — FINAL PLUMBING
W Q Lcddcr.,Name
.a7 Z Icoder'1Address 508 — FINAL MECHANICAL
U O 1certifyoc 1have read this
tyandaounandstatethmthe above wsrelatingis 509 — FINAL GRADE
0 U building 1 agree cern.and with all city r refer ordinances and curt laws relating e
O f,J building construction.and bcrcM1y awhorirc rcprcummivcs of this ciymcnmrurym the 5 FINAL PLANNING
r W abm
ove. emioncelproperlyforinspectionpurposes. 14 FIN LI W RKS
>, 4L (We)agree to save,indemnify and keep harntles the City of Cupenim against
zp liabilities.judgments.costs and expenses which may in any way accrue against said City
U Z inronse'YWP�enec nl'the granting dl this permit. /)
r. APPCICq NT UNO[RSTANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S USE REGULATIONS
Re-roofs
arc of ApplinnUConamend Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thri,pheant dr fmure buildin w.a am store or handle hnardous nominal
as defined by the Cupertino Mmurip ode.CbapMr 9.12,add the Health and Safety
we.Section 255axarr All roofs shall be inspected prior to any roofing material being installed.
❑Ycx
Will thea Eran�m mmre Wt Kra m use a goipm em un devices whichIf a roof is installed without first obtaining an inspection, I agree to remove
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emit hazardous air contaminants elided by the Bay Area Air Quality Management all new materials for inspection.
Disviot/
❑Vis E]NO
1 have dad the harerdoumamrial.v requiremems under Chapvrfi 95 of the Califor-
niaflcalthA ey Cssk.S ucm25Y)5.25533ud255}.lundcrsur ifdo,Wilding
dress not fly have n moon 't it i mY resgntsibility m nonly the n<upim of the
regni whirnmastru,issaanreoraanirrate arupx Signa
ture of Applicant Dale
weer or aomoazod agent (tet/ Dia All roof coverings to be Class "B" or better