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08020055BUILDING DIVISION PERMIT 13UILDJN8 aWS PERALTA CT OWNER'S NAME. HUGH MOLOTSI ARCHITECTIENGINEER: 1 hereby affirm That I am licensed under provisions of Chapter 9 (commencing vith Section 7000) of Division 3 of the Business and Professions Code. and my license is n full force and affect. ,icenseCfass f co r _ �W���0� talc _�„i/ ontradar ARCHITECTS DECLARATION I understand my plans shall be used as public records -icensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ,'allowing mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure nrior to its issuance, also requires the applicant for such permit to file a signed statement khat he is licensed pursuant to the provisions of the Contractors License Law (Chaprer9 ;commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pemlty of not more than five hundred dollars ($500). 111. as owner of the property, or my employees with wages as their sole compensation, wiR do the work_ and the structure is not intended or offered for sale (Sec. 7044, Busing and Professions Code: The Contractors License Law does tut apply to an owner of property who builds orimproves thereon, and who does such work himself or through his own employees, provided thatsueh improvements are not intended or offered for sale_ IL however, the building or improvement is sold within one year of completion. the owner - builder will have the burden of proving that he did not build or improve for purpose or sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Cade:) The Contractors Li. cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a cont acmr(s) licensed pursuant to the Commcwes License Law. ❑ 1 amexempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Workers Compensation Insurance artier and Policy number arc: Carrier.. 54-"+G Vomer _ _Policy No.:,.id-(.I -00;042.5 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workces Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address I certify that I have mad this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building concoction, and hereby authome representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE R ULAT70NS. il^ 24 2-GOE) Signature of Applicam/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant state or handle havxdous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Yes 0140, Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? Yes �No PERMIT NO. BORREGO SOLAR SYSTEMS INC 1 08020055 PERMTI ISSUE DATE 727 ALLSTON WAY SANITARY NO. CONTROL NO. ROOF MOUNTEDGRID-TIED SOLAR Job Description Required Inspections Issued by: Re -roofs Type of Roof BUILDING PERMIT INFO Valuation Date -2_-2-G 2-G f 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 all new materials for inspection. I have read the haiardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the reymremcnldlvhrch must be to issuance of a Certificate of Occupancy. Signature of Applicant Date -► /n L An ---f,. t.rinac to he Class "B" or better