08040207 CITY OF CUPERTINO `'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATI,ON
z'3;a„% 'Y.n_<,h �.
BUIL GSID FSS: PERMIT NO.
� RANCHO DEEP CLI DR REGRID POWER 08040207
11Z
NLAME: PERARI ISSUE DATE
RAPH DUNIWAY 1624 DELL AVE 05/08/2008
PHONE SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHIECTIENGINEER: BUILDING PERMITUKFO
BLDO ELER PLUMB MECH
O LICENSED CONTRACTOR'S DECLARATION Job Description
wF
w`ai 1 hereby affirm iEat 13 li¢vN under Pm fcsa of Clupl, 9(mmmeKing
wisuS.tion lgkO or Divltian Jofde eusineu sed Pmfrasiau Gode,aed mylkcnxu INSTL SOLAR(PV) SYSTEM ON RESDNT'L ROOF
j22LD full for¢and ertµv , a
Lken.Cl. `� Lic.N
F aw out Me
`q ARCHITECTS OEC RATION ar
D a understand 1 undernd my plans shell he used as public records
o Licensed Professional
OWNER-exempt fr DECLARATION
I hereby Affirm that 1 1. exempt from to Conu.thrs License Law for IW
a o following toressen.(Svtian 7031.5.Business and Pmfeaium Code:Any city or county
$ with rite isu a permit w cons;the .ler,improve,h permit i ri ea sig ed tuum rat
_i y mon
et he i its Tensed p also n t to
the of for act permit Lice s,Law tCaarment
ppmmC
met he escingwitpuramt to the provisionsfDvafthceBuscwrWcevelaw(CMpmr9 Sq.Ft. Floor Area Valuation
YF that he
S.dmst and the
Divisionr OfIWBuincxmpton.professions Cade)or $26900
y $
that be u 3IJ by
thcmfmm and 0e burs for Ne alleged exemption.Any violation of
sun m ]OSIS five
arty red dot for a permit abjms du applicant w a civil penalty of Number Occupancy Type
^.n ream than fine n.ndred donate(xsao). 35602045 ! P Y YP
L u owner Of tk papvty,m my employees with wage u the'v sole compeuation,
.IN da the work and to syucum,is not in¢MW or offered for sak(San.7046.Business
and Professions Ccde:The Contractors License law does act apply to an owner aRequired Inspections
property who builds e,impmw Nemon,andwha dcessuch wmchi sm1forNmugh his
awocmployres,provided that such improvements are ret intended oroffeand for uta IL
however,the building m'ungavemrat u sold wiNin one year of mmpkdon.the owner-
W ildv will love the buNcn of proving that M did MI Wild or improve for pumax of
ale.).
❑1.Is mares,of to property.am exclusively contracting with licensed centrsctan to
mutlact the project(Sec.1014.Business.M Pnefessics.Cade:)The Com came.U. .
cense law does not apply to an owner of property,who builds or Improves thereon•and
who contracts for such pmjecu wit a contractor(s)Ikamsed pursuant to the Contractor's
License Law.
0 I am exempt under See .B B P C for W;rets°°
nv Dau
WORKER'S COMPENSATION DECLARATION
1 hereby air=under Xnaky of perjury arc of the following declamations: .
❑Iharcond willmsinuina Cutificsu.fCouenu.self-Wore for Warkcrs Compcn- ”"
sada..as provided for by Section 5100 of the Labor Code.fm de po fomaress of the
wart for which this remit is issued,
❑1 have and will mama,Workers Compensation Immuno,Is cyuired by Section
3100 ufthe Tabo,CoM,for the performance ofthe wood,fmwhich to Permit Is isre '
My Wmr ssyCjompensation huurance carrier and Policy number are:
csnlert////LI tsLa' Poliry No,C 42,0°70J 9� 0 �
�IFlGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xNon IeN ret he cmnplewd if to remit is for one hundred dollars(S 100)
or cu.)
1 cemi(v that in to performance of tc work for which this permit is 121N.I shall not
employs, comm in any muck'.Is in homme abject to the Wo enrI.COmpeusum, -
Laws of Caliramis Dau
ApPlicutl
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject m the Waters Compensation pmvuiou of the late,Co,,you most
.,O foMwith comply with auch provide.or the Permit shall be deemed nevokel.
CONSTRUCTION LENDING AGENCY
(•'> the wort hereby
air=y Item u a construction lending agency for the performance of
a permit is iu^ed(sec.5091.Civ.C.)
Cp tender's Name
Z Lenders Address
U Q 1 crtify tan 1 have mad tis application and sou tat the above illromadun u
comet.I agme to comply with all city and county ordimmm end sum
m Irma missing
0 buildingc.neunetion,and hereby mt.dm mpmxntalives of this city w enter upon the
W above-mentioned property for inspection purposes
g1. (We)agme to eve,indemnify wall keep hamlet the City of Contends.agar st
h liabilities judgments.costs and expenw which may in any way.erue against said City
V 2 A APPLICANT
of the UNDERSTANDS
of the D WILL
Issued b
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PoINT y; Date
SREGUTATIQK
aOlln
Stgwurto6�./aD
—P Re-roofs fAWlican nuamer
—�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win the aPPliant Or future building 0ecometstore or hatldle huandou material
u dc0.d by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safdy
.Section 35531(.)?
C3 Yet )(No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan ins ction,I agree to remove
Will to applicant or few¢Wilding occupant esu cyuipmem or devices which Pe g
emit harsrdou air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DisuictT
❑Yes 14No
1 have read the huardoumsurials reyuimmcnu undcrChapurd.95 ante Califon.
nu HulthkSxfcty Code Scc6=Z505.25533u 25534.1uMusu^ddutifdc building
dos ttoI cmrentiY haw a unset,thus it u my respauildlilY w notify the ucupam or to
myulID entswMenmaxlxmm'mwisaee.f.Comr, r OteupVY. Signature of Applicant Date
rnn f All roof coverings to be Class"
ser or authamcd agcn oto_ g fT`or better r