08060067 CITY OF CUPERTINOxs+t°'u
BUILDING DIVISION PERMIT .CONTR'ACTOR, INF,,ORMA,TION,.
28ka?
BUIL INGA KESS: PERMIT NO.
,10$� RAINBOW DR HORIZON ENERGY SYSTEMS 08060067
R'S NAME: PERMIT ISSUE DATE
JATIN PATEL P 0 BOX 320612 06/20/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 395-9060
ARCH IFECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
upp LICENSED CONTRACTOR'S DECLARATION
rd 1 Irseby affirm Ws I am licenced under provision of Chapter 9(onmmeMing Job Description
n wiOSection)000)ofDiviaion3ofNeBuenrssmdProfebionsCodc.andmylkenwis PV(SOLAR ELECTRC) GRID-TIE SYSTEM
s in fun farce aM CorLicense Me L'c.♦
F O Dem Canlrac(ar X
ARCHITECTS DECLARATION
W U 1 understand my plans shall he used as public reeoms
len
am Lrcerucd Professional
eb3 OWNER-BUILDER DECLARATION
un
1 boreby alum Nal I I. exempt from the Communes is : n y c taw for IW
N O following reason.a(Section]ull5,Business and Nvfde oli Cade:Any city or county
3$ which its a permit o.i=ce L alcor.rte prove,demolish.t ore a sig any structure
_Z< pear m its pursuant
to ft Nprovisions of for such permit to rile.Law sutemcnl
ESQ
that
onesn"hol; itpurswnlre00)ofDvsion oftheSthou uinessMdPref.w(Chapter ode)9 Sq.Ft. Floor Area Valuation
Y 5 that M ncexach, Section RMd the
harinsof r of al eg Business Md Professions Cade)of $33864
— Nu io V ems b my S,m and Ne burs for bj alleged emmpuon Any violation of
Section 7031.5 by arty epplic ll mr a permit subjects Nc applicml o a cion penally of Number Occupancy Type
icor more Jun Rve hundnA dolWs(5300} 36626025 . p y yp
0 I,Summer of Ne property.army employca with"gnu then sole compeaadon,
wiRdods rkandIWs =urotin¢ndedmoffaed(orsW (S¢.]OM,Business
and Professions Code:The Contractor's License Law dors not apply he an owner of Required Inspections
property who builds orimproves thereon,and who does suchwerkhimselrar through his
own employees.provided that such improvements menot intend moRsrrdforsakeif.
however,Ne building or improvement is cold within one year of completion.Ne owner-
builder will have Ne Wmce of proving dol he did am build m Improve for purpose of
ask.).
❑1,as owner of the property am eaclusively contracting with ncemed cenuanon b
¢utrom Ne project(Sec.]Ossa,Business ood Profaoou Cod,:)The Communes U. '
erotic law dors not apply o in owner of property who Wilds or improves thereon.and.
who contracts for such projects with a contrasm(s)licensed pursuant no the Co nuactor3
Lice.law.
rem
came Is
undo See ,B&PC for this moon
Dam
WORKER'S COMPENSATION OECLARATON
I hereby+(Rens under Nulty of perjury ane of the fallowing daclaadou:
0 IbS. mdwRlmairmm.Crrficmc fCarue.toself-iuureferWorkersCumpon-
auan,u provid (Pe by Section 3]00 car Ne labor Code,(m Ne per(orman¢a(Ne
work for which this permit is issued.
Jhave and will maintain Worker's Comparmal n Instorm e,as required by Suction
o!Ne Labor Codc,for Ne performance of the work for which Nu u Wood.
ued. '
My Worker'sa Compensation Lance es . and Policy number art:
Career. !:�! F_ -/_licy No.: ?T O 17 t 3:3—Z Com`�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Itis suction need cot bo completed if Ne permit is forane hundred boilers(SIM)
nr less)
I certify bet in the W(hernanee of the work for which Nis permit is issued.I shall nm
employ any person in try manner an as IS heromc subject b the Workc,S Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT IL after making Nu CmUrinle of Esemptian,you should
become subject o Ne Wohees Comp seardon provisions of Ne Ica Wr Codeyou muss
0 z forthwith comply with such provisions or this permit shall W deemed revoked.
Z O CONSTRUcnON LENDING AGENCY
[-+ Ihereby&Mom Nat Vert is a combustion lending agency four the Performance of
1a> dre work for which this Permit IS iau di(Sec.J09),Civ.C.)
W� Z Lsndue Name
z Lender's Address
U O 1 cooly that 1 have mad Nis application end scale Nal the above informauun is
IL correct,1 agree to comply with all City and county ordinaK,a and anile laws mount re
-0 Wilding convection,acrd hereby mmenre mphearnuuves of but city o enter upon Ne
H ya evc-mcnuuned properly for inarconn purposes
(We)agree o ave,indemnify tad k¢p hamless the City of Cupertino agtlat
LA limiliues,judgments,costa and expeua which may in any way mcnb against aid City
V z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMP Y WITH ALL NON-POINT Issued by: Date �/-(�
SOUR RRR.UI.ATO
IV Re-roofs
Signeort of ApphanUCoffiscre, me
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or to,=Wilding occupant¢sort or boodle haumum mom us
Recd by the CuNnino Municipal Code.Chapter 9.11.and Ne Health tad Safely
.Section 255314)]
❑Yallo All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicml or future Wilding aceupanl me or,uipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
�S fcaaiudom air contaminants u iclined by the Bay Arca Air Quality Management all new materials for inspection.
I have real the huamws me enmenequiremenuundcr Clu ner6.95 of Ne Cali(ory
nia Haled&SafctyCede,Secdou255U5,25533md2553a.lundcramndthdrfN,Wilding
doss tit currenll ve•count,bol it u my rapaaihilily b motif ib¢cupml of me /� Z
rcyuire ooh mut be mel um¢of trot te eupsmy. v
� Signature of Applicant Date �
aummmmthmi,.edagent U212 All roof coverings to be Class'AS'or better