05010150 ;'C'l"DI
TY OF CUPERTINO ' °*�y ,y&ya�+}��. "/'�z� +*a^�;`.�a s T//.•.��tt.���
BUILDING DIVISION PERMIT GONT12ACh1'QR TNFpOIi A I T:
NG ADDRESS: SUN LIGHT & POWER CO. PERMITNOO 5010150
44 RORTNI)FT.T. WV
ER'S NAME: PERMIT ISSUE DAIS
BRIAN STROM 2005
E: SANITARY N0, CONTROL N0,
510) 812-8241
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
I U I hereby affirm that 1 am limnW under previsions of Chapter 9(commencing p
with Sec0on7IX)F)oroiviaionlof du euainw ane ProfceTi n Code.and my lice=is
imm�rmeand t. SOLAR PANEL/INSTALL .PERLINE /DIAG.BRACING
e—Z Licenm 1 Lie.Y
R-2 Date Contactor INVERT AC/DC DISCONNECTS ON EXTER. WALL
ARCHITECTS DECLARATION
C m 1 undcomool my plain shall be used u public mcnrds
a
S0 Lice=d Professional "
Oat I am exempt F DECLARATION
1 hereby allure on I am exempt Prem the Contractor's Any c Law for the
•O O following mason.Permit
,IIn 1.3.Buaiws and ive,do ion Cook:Any city m county
$ which requires a pewtl re rnntrucL slur,improve,demolish,or mime any swctum
_Z'tn
poor heisIl suldugalsurttothe provisions
of for dc,Cchpermiaolle x.Law luive,t ti0000-
< (that conowslicc=dPuauant70th)pmvisionofccConuator'W¢=lsw(Chnpur9 Sq. F[. Floor Area Valls$
e�� (commencing with Section7000)and IN hasis n l of th)alleged
Business and on.Any
vi Code)or
e�— WI he"is acmpt ccrt(rom and Uu buts for the Wegcd eampdon.Any violation of
Secdoa 7031.5 by any applicant fora permit subjects the applicant w a civil penalty of APN Number Occupancy Type
not moo Nan five hundred dulha(8500).
❑I.aownuofthepmpeny,umyemployeawithwagnacVWIC MPC=Linn, 36223011 . 00
will doPrefiesid kandth The Contexture,
docaunt applyowner
Ij�(pl}r�(I I't)s C OD
and property
wh obu Code:The Conmcwh Liaho law esu not apply lf rt owner of _}ttf]�'1+7upt'UY�.�,IfiBI
own enywho buildsviimproves chicon,andwho duessuchwork himself d!through his
ownemployes,ping or i prsuch tmpremments are
myearn exi fcmplefi W for ownIf.-
huilde' the Wilding ortmpremmentis solewithin oldWeldofcompletion,theowncr-
builder will lues the burden of proving cat k did nm build m Imprem fes peryom of Z��5
ak.). FFR
❑I.as owner of the properly,am exclusively)ambling with licensed Cenlnetpn to
conmmt the project(Sec.7044,Business and Profession Cade:)M Conuacur's U.
ccne law des not apply as an owner of properly who builds or improves thereon.and {{'' pp( p .7�as. w 1�
who contracts fm such pnjects with a comracbr(s)lice=d personal to the Contractors }I$ G 'i y, �y
Lice=IoW. IWI'ppm CpvY"i 6 B W
❑lam exempt under See .B&PC for this reason
er Data
WORKERS COMPENSATION DECLARATION
1 booby affirm under penny of perjury ore of the following de elantiusu:
I ham and will murrain a CemOwu ofCo=rata self-insure For Workers Cori
nation,as provided for by Sections 37M of the user Code,far the perfowancc of the
for which this pormit is iadued.
1
have and will maintain Workers Compensation Insurance,as required by section
or c)labor Code,Ire the poformanee of the work for which this permit In sued.
My Wo ompe=tion Insunna came and Polityn sober art: .
Cartier. S Policy No.:
CERTIFICATE OMEMPION FROM WORKERS'
COMPENSATION INSURANCE '
(This motion red not b)completed ifthe Permit is Insists,hundred dollartanI )
of lead.)
1 certify cat in the performance of the work for which cis permit u hunt.10.11 not
employ any person in any moneran as to become subject to the Workers'Compe=lion
laws of California.Dau
Applicant
NOTICE TO APPLICANT.If.afar making this Ccnifcau of Eacmption,you should
Immune subject to the Worker's Compensation previsions of he Lahm Code,you must
Oforthwith comply with such pruvuiona or cis permit shall IN deemed invoked. . .
Z� CONSTRUCTION LENDING AGENCY
1 hereby ahem that them I..construed.IUWing agency for Nth performance of
x 7 the work for which this pewit is issued(Sec. 097,Civ.C.)
QLender's Nwc
3.7 z Lender's Address
;,)Q 1)entry that I have Mail this application and use that the above information Ian S/
y cows I agar a comply with all city and county wnu
tnas end ts Iowa relating
�U
Wilding construction,and hemhyauthonm opraewinutima ofNiscity loonce upon the
M, Move-memioned property for inspection purlexa
(Wd)agree to ave,indemnify and keep harmless the City of Cupertino against
Ilabilitta,judgmcnu,Co. d expenses which may in any way acemc against aid City"rube
J APPLIin CANT t) Eg Ang of D WI MPLY WITH ALL NON-POINT Issued by: Date/ r(J
SOU GULAT
Re-roofs
Signature of Ap mVCantrmmr
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or town building occupant atom or handle harudous manual
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Section 355330s)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building occupant use equipment or dcvi®s which If a roof is installed without first obtaining an inspection,I agree to remove
Id.
Wardoa air contaminants a defined by the Bay Arca Air Quality Management all new m rials for inspection.
❑Yea ❑No
1 have mad the harewous materials requiremonu underChepter6.95 ofthe C4hfor.
eol&Smctyc cdum35N)5,35533ad35534,lundeuundcaifce Wilding
not curmnll ha a mol.cat it u my responsibility to notifyrem " here"pct° eNn' cupancy. Sign a of pp Icant Date
own)r archin r=d ochre Dow 40All roof coverings to be Class"B"or better