08020160 CITY OF CUPERTINO �.t� -+r�'a7!Fry�f.+�+ 'ra. ♦^
BUILDING DIVISION PERMIT CE�ytnyll[''l.lV,R INF�RMAI(O
BU B"TWSSTICENIC BLVD REGRID POWER PEa08020160
OWNER'S NAME: PERMIT SUE DATE
BLACK LYMAN D AND DEBRA A 1624 'DELL AVE 03/13/2008
ONE SANITARY NO. CONTROL NO.
ARCHI ECTIENGINEER: BUILDING PERMIT INFO
INSTIL SOLAR ELECTRICSYS ON BLDGELECT PLUMB
fom NMEcx
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Sap LICENSED CONTRACTORS DECLARATION Job Description
1 barely arat 1 am focused-suer P--W--of Chiller 9(crome—ing
i with Section 700E ol'DiHuon 3arms,Business and Pleftatoov Cade,and my license is
< in full forte and al ���-1
Z Lkenn Cless CIO Lk,e
�'FFF�Ft� Dam ConlracDEmrAR neves Lia
sS ARCHITECTS CLTIOt
1 mmar ad my
Plans"i be used u public records
yup
Licensed Protests anal
^ OWNEmBUILDER DECLARATION
I hereby strum on 11. exempt ,an Ne Contactors :My Law for Ne
ypO
followinga.(Section 71Omv Brune. or Pmlasimv Code:My city orrounty
$P°i nim t rtquis a n perm re cavlmo.ser,nt rot su demolish.m e A lir ns'numure
�1^ priormiu issuance,also requires ma applicant far such Permit to Eleaaigttd statement
gg "he is licensed pursuran(to the provisions of me Contractor's Liannass Law t0hapect 9 Sq.F O000rArea Valuation
4�a (commencing with Section 7M)of Division 3 of Ne Business and Profwions Cade)or
..
that he Is exempt Beardless and ms,basis for that alleged exemption.Any violation of
Sectlon 7031.3 by tory,applianl for a Permit subjects Ne applicants o a civil Penalty of APN Number Occupancy Type
an more Jam five hundred da1Wa(SSW).
❑t.u owner of Ela paperry,err my employcea withwrA u Ja4 robe compevadm,
will do the work.and the structure is not intended or offered farsue(Sec.70(4,Bwinw Required Inspections
led PlefeWom Code:The Conmcmers License Law data not apply to an Owner of q p
Property who buildsor(mpleves Neuron,advrW dcesauch workhimmiform sough his ,
aweemploym,parldru roto such imp.crets ale rat intended moffertd fmaale V.
bersever,Na Wilding or impmsmrnt is said Whin arc year of nsspledaa.the wmer-
Wilder ME have W lumen of proving that he did net Wild or improve for purpose or
sas).
❑1,as owner of de property am exclusively co meting with licensed rontamara to
common the pmjca(Sec.7064.Business and Rofessions Code)Tie Communes Li-
eeose Law does not apply at an owner,of Property who Wilda or Improver dereon.and. _
who conoicufor such projects;with a eanuamot(s)licensed ram u,m me Contrsamrs .,
License Law. .
❑I am exempt under See a k P C for this meson
w e Dam
WORKERS COMPENSATION DECLARATION
1 herby affirm under penury of pehmy arc of the fallowinguniods,curatioura
❑Iham and will marry Section
of CoventmCode.for so performance f r provided lPe by Semon 37W of Js,ISWr Code,far Ne Perfanneuott of Ne
work fm which this Permit is issue.
❑1 have told will msinsin Walkers CompevWon Inwrmce,as required by Sudan
37M ofdoe Labor Coda,far the pRarmatt afore work rot which this permit slaved '
MyWakmesComprvad rs mnrnce artier and Policy number am:
Carer. IM tA'l-LS'fiL r^vr WPullcy No.: Cl-OOT 0p t1 1
W&OF EKENI MUN FROM WORKERS
COMPENSATION INSURANCE
(ITs section need rot he completed if tad Permit is furans,WnNad dollars,($IBM
roma)
1 merely Not in Ja perform.of the walk fa which this Permit is heated,l shall not
employ any Parson in ley manner an u as became subject to Ne Workers'Conformation
law of Califamie Dam
Applicant
NOTICE TO APPLICANT.If,after making this Cenifcam of Exemption,you should
become subject m the Workers Compensation previsions of Ne Labor Coda.you muss
.,O foMwim comply wit such provisions or this Peenit"I be do mol rooked.
zy CONSTRUCTION LENDING AGENCY
E+ Iherehy.M.mar tare is aconsmocdnn lendingagoey for me amfurraecaf
ai > the work for which Ns Permit Is unseat(Sec.3097.Civ.C.)
WM Q Lenders Name
]z Lende'sAddress
U O 1 error,that 1 have read most application and sum mu the move information s
pL !'. correct.I agree m comply MN all city and county ordinu m,and arae sws relating to
0 CSJ^ Wilding construction,told hereby m0min oprexamatiwa of this city to enter upon the
{37 above-mentioned property far ivpeman puuposea
(We)agree m save.Indemnify and beep harmless the City of CUpertia spinel
oUy Iiabilita,jWgmenu.cosundexpwu whichmaylnnywysmmagalvl WdCity
U Z in consequcna of the grating of this Permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ 2
SOURCE REGUL NS
31I1162- Re-roofs l
Signature of Appli onuacmr D
At Or run=building MATERIAUS DISCLOSURE Type Of ROOF
WIII y the Client or future ipal a,Chaptnort m Mobk huudom material
u dcOrod by the CuPeninO Municipal Cada.Chapter 9.13,and the Xea1N and Safety
mc,Section 35532(a)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yta iya.0
WIII the applicnl or Powre Wilding avupam arc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit husNaua aur cmumianu as derUad by tie Bay Area Air Cosily Management all new materials for inspection.
District?
❑ 1 /
m ldYm
1 have read to hvamrmsmamrialamquiremens under Chapmrd95 of hreCalifor-
niaHtalNhSsfmyCada.Scemvu255D5.25533 and 35534.1 urldcnsunld Nnifine Wilding
data rol,utmmy have a uawk that it is ms'responsibility to notify the m oupar of the
mquiarroom whic� ma 'arm issuance of a Certificate of O vcy.. Signature of Applicant Date
owmerarnNa�((a ��eLnt/ � l' Das All roof coverings to be Class'A!'or better