06050149 CITY OF CUPERTINO `
BUILDING DIVISION PERMIT ;CONTRACTR INFORMATION r
BUILDING ADDRESS: REGRID POWER PERMIT N0.06050149
10142 N PORTAL AV
ER'S NAME: PERMIT ISSUE DATE
DENNIS HADLEY 1624 DELL AVE 05/17/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHr1ECT/ENGINEER: BUIIDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
:Cp LICENSED CObITRACTOWS DECLARATION Job Description
mF 1 hereby affirm War 1 am licensed model ProVISLOM of chapter 9(commencing
ti`s$ wit Section of Division 3af circ Business and Pmfessians Codc.md my license is
infmlmmeama INSTALL SOLAR ELECTRIC SYSTEM
Liccnu CI s Lie.« —
;I-p Dale ComrYbrIse
1�Y ARCHt1ECDECLARA 10
f a I undersand my plans shall he usem d n public meads
)yU
o Littnud Pmfcssiaml
tat I am exempt Dr DECLARATION
� 1 hcmhy affirm Nal I am exempt Wm the Contractor's License Law for the
00 following lesson.(Section 701.5.Business and Professions Code:My city or county
2 F which".i.a Ferrol m..L eller.improve.demoliW.Or repair any swnum $31129
-Z< prior m its houaMe.also mi,the)We applicant forsuch pemtil to rile a signed statement
S Nat he is liecoud purauamm We provisions of to Contractor's License law(Chapter 9 Sq•Ft. Floor Area Valuation
e t'9 (co he is eag ips Smfram and th basis m l lbea Business end On.M vi Cade?of
y�� drat be u eumpt huefrom and cite buts for cite alleged eumption My violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of Mlilllcr u u Occupancy Type
not mom than eve hundred dollars(5500).
0 I,u Owner of de property,or my employers wit wall as Weir sok compenvtion,
will do Be.,it.and on,asrYmum u not intended oraffucd foreale(Sec.]BN,Business Required Inspections
and Pmfessimu Code:The Comrumfs License law does e tet apply m an owner of q p
Prorcny who builds Orimpmves tenon,mdwha dmssuch work himself ar dwugh hu
awn emplaya,proMdW Wroverm mpnsvements art not year
ofc maRenil to owner-
builder e lrhawder,Nedullinghu ion ofprovinuhaltwhinoroyear orcompletion,tosoeLwill haus dm Widen a[proving that he did not build or improve for Puryou of
sok.).
❑1, a Owner of the Sec.7 .B uclusiv and
converting Cod:)Th ed anvermrs U.
mm,La d project(Sec.]Ora,Business and nyProtectorswh hat Code:)The Commcmra d C
cense law dor not apply] an owner of prorcny who builds a art,sow Onium,and.
who convacu far such projects wits...,.,(a)licensed pmwam b ltr Conuumfs
License law.
�I ton tempt under Sec ,B&P C far One reason
Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under Family of perjury one of the following declarations:
❑Ila m prowidl ForbyneCion 37M of the
Owns.fur elm Wnfiann Ca of an
ration,r provided(pa Ey S.assn 7]00 of circ Labor Code.fm We performanea of he -
w�or/k for which Nis permit is issued.
0 t have and will maims).Wartrrs Compmamian Insurance,as uyumad by Sccum
3700of tm Lather Code,for to prformanee of to work for which this Permit u issued.
My Workafs Cc�,s.yop�e..numnn In�s�ur.at.carrier and Poll,number am:Came,. Policy 'I0QQd .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU uetlon need not be completed if to permit l for one hundmdda tars(5100)
or less)
1 reify Nat in to perfolmanee of he work for which his permit Is issued,l shall not
employ any person in any manner—w c Elect to the Workers COmpevation
Laws at California.Dow
Applicant
NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,you should
become sublcct in the WOrkefs Compensation provisions of Lha Labor Coda you must
.,O fOMwih comply width such Provisions or hu mall all be dcamed revolted.Z" CONSTRUCTION LENDING AGENCY
[-ice 1hereby.M.Out Cert us eonmucunm lending agency far h.performam.of
<Y>
to wart fm which tis Permit is issued(Sec.3099,Ci,C.)
WM Q Lenders Name
Z Leaders Address
U 0 1 certify that 1 have mad this application and state Nat he above informadun Is
Li f" cancel.1 agree to comply with all city and county ordinances and state taws raising h
DU building construction,and hereby auhomr mpresenutives of this city to enter upon to
r W above mcmioncd Property for uspecuon purposes.
t„i 0. (We).,me m save,iadcmni fy and tap hu mess We City of Catania.agaiaal
rn liabilities,judgments.emu and..pensca which may to any way accrue against said City
U Z in contequenee of the granting of hu rc rah. v
APPLICANT U DE/R�1STAND AND WILL COMPLY WITH ALL NON POINT Issued by: Date '-7-6
SOURCE REG T//d�tQ�//�rjj 1}/
Signetum of Appi ommctor � �/L /Dake Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will he applicant or(mule building oaapanlse o Or handle hazardous material
as defined by the Curcrtino Municipal Code,Chapter 9.11.and the Healt and Safety
.Section 25532(a)1 AN. All roofs shall be inspected prior to any roofing material being installed.
❑Yes II��� If a roof is installed without first obtainingan inspection,I agree to remove
Will it applicant of fumm building occupant use Ail Q.or dcvims which g
emu ick? s air calluminanu as defined by to Bay Arta Air Quality Managcmcnt all new materials for inspection.
District? `/
❑rca @ N.
1 have read the hvardms matedal mquimmcnu under Chapwr6.95 of teCalifor-
nia Hca1N&Safmy Code,Seeums 35505,13537 and13534.I undcrsund hatifNe building
does not rmnd hav tenan4 to it u my mapomtbiliry m mu y ire Pant of he
Maui rt en rot bem.tpiaFm ,raa:araCrdeca sap Signature of Applicant Date
owner aranm l -q D,P. All roof coverings to be Class„B"or better