08080021CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT N0.
92'/ ROSEBLOSSOM DR
AKEENA SOLAR, INC
08080021.
NEWS NAME:
PERMIT ISSUE DATE
/\I,:,GN CHANG
1.6005 LOS GATOS BLVD
08/11/2008
NE
SANITARY NO. CONTROL NO.
ARCHITECf/P.NGINEER:
BUILDING PERMIT INFO
INSTALL 20 ROOF MOUNTED
BLDG EO PLO
O
LICENSED CONTRACTOR'S DECLARATION
sehAR
lob Description
I bunchy affirm Thal 1 am limmed under Provbians of Caper 9 (ca ..let
with Scetion 70011) of Division 3afdw Business and Prolcsdans Code, and my Iiccom Is
in full ranee and effect. $ O -73
License Clw Lb. a
De¢ Contrrobr
ARCHITECTS DECLA N
1 understand my plana shall M used u public records
Liemped Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am eaempl fount Ne Contractor's License Law far the
following moon. (Seed.. 7851.5. Bustran. and Pnefessians Cade: Any city .1 ..my
which requires a pemlit on ennurow. Wu, improve• demolish. or mial any structure
prior N w isommm. also requires the applicant forsuch Permit to Ole a signed statement
Out a is licensed pursuant to to provisions of the Contracts, Lime eLaw(Chapter9
Sq. Ft. Floor Area
Valuation .
(commencing with Section 7000) of Division 5 of the Business and Professions Cade) or
that IN la a-mpt therefrom and the bub for tis alleged comp hm. Any violation of
APN Number
Occupancy e
Y TYP
Section 7051) by any applicant for. permit wbjeeu two apPlimnl u . civil penalty of
Out mom Nan five hundred tlMWs ISMP
1, u awmr of Ilio popsty. s my wploy=with wags u Neo rob eampewdon,
Required Inspections
e nst
will do ON wadrind Nemucmm is ON mumded saResed ranalo(Sec. 7044, Bauenw
and Prefessimu Code The CanuacurSmLaw w des reapply to an owner a
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propny, wa bunds or leap unws dom men, ane who deet such warthimulr s Nrovsb his
own amplayma, provided Out such Improvements arc not intended salimed for sale If,
however, Ne building s Wpmvemmt is sold within ore year of rumpled... Ns owner -
builds will have dm bur lm of proving Nal he did ret build or Improve for purpose of
tib.).
❑ 1, as Owner of i m propny, am exclusively contracting with licensed mnlruetans u
construct the project (Sec. 7044. Business and Profession Code:) The Contr.cur's U.
comse law dors not apply in an owner of property who hull" or improves Merton, and
who conumus for such pmjecm with a conu.cuNs) licensed pursuant on Ne Conuscuh
LImn4 Law.
❑ lemeaempundersce. ,Ba PCTSNismuon
Date
WORKER'S COMPENSATION DECLARATION
I hereby ff.. under pnsity of perjory one of dw following declwd.
r' I have and will maintain . CeNOnta of Consent to self -Ilium for Wormes Compam.
wire• u provided for by Sermon 5700 of Me Labor Cade, for alta performance of IN
work for which this permit is hawed.
❑ 1 haw and will maintain Wor eves compensation Insurance, u required by Semlan
5740 of one LaborCode. for the perfformar. of Ne wsk for which his premum Wood.
'
My Worlmea Compensation ln.Wnmc carrier and Policy number an;
Carrier.�� n F 7n rl Policy No.: t 3'%�
RnL FlCAIE OFE PION FROM WORKERS'
COMPENSATION INSURANCE
(This section nand ret bu completed lithe permit is twos hundred dollars (51(0)
s les)
I cenify, that in Ne pmrmmanm of la work for which this permit is issued. I mall not
employ anypermn in any mccncrmo u u become subject tithe Workers' Comp rwation
laws of California. Dam
Applicants
NOTICE TO APPLICANT: If. Mer making who Ceddfium of Exemption, you should
bmome subject u Ne Warkels Compensation provbims of Ibu labs Code. you most
foMwiO comply with such provisions or this permit shall be deemed rewkcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm and, Noe is a coulmni.n lending agent fear Nn pmferromwe of
we work for which This Perot, Is Wood (See. 5041, Civ. C.)
'
Lemicea Nurse
,
lenders Address
I cuddly that I haw read this application and mm ON the above information is
.
ounces. I &goes u comply with all city and manly ordinances end slam laws relating to
building cmuuuction. and hereby authorise mpm robes of this city to enurupnn the
above-mentioned property for Inspection purples.
(We.) agree to... indemnify and kap hermlw the City of C'uperhna agunss
liabilities. judgments. core and expenses which may In my way amore against sued City
in consequence of ON granting of this Pmnll.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
< 9/11/01
Signotu 1Applien✓Cannanur /Dau
HAZARDOUS MATERIALS DISCLOSURE
Will ON spold ens or pulse Wilding occupant sum or handle, hauMou& material
u deBmd by the Cupertino Municipal Cade. Chapter 9. It and the Health and Safety
Sectio. 1555y(a)7
pYea ?4+o
All roofs shall be inspected nor to an roofing material bei. Installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant u- equipment s devices which
.til aaudnu sir canuminants u IkfinN by Ne Bay Area Air Quallly Manegcmcnl
all new materials for inspection.
Diwictl
❑YN [I No
Ihave Lheam mam4atimW!mmmtsumlerClupw6.95OrlaCali1s-
nuHsaaSemy Ca .Smliwu M5 .2555am12S534.1uMnvmd Nnifde Wilding
does not cuncnsly have a smart, ON II IS my msponsih8ity N ramify the-msupant of the
requirements whch rune IN .1 poor In loam-= of. Ceddfrau of occupancy
Signature of Applicant Date
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All roof coverings to be Class '%{" or better
ow er maria=aegem Dam