02010108 (2) OF CUP
CITBBUILDI G DIIVD'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1145 STEEPLECHASE LA MC SOLAR ENGINEERING 02010108
SN1FWAA'ffb YUSEM 1168 ASTER AVE 0T'I'DC/ �DM
PHONE: (408) 261-1211 SANITARY NO. CONTROL NO.
a zG ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
ai f-1 t—t LJ I_--1
y= LICENSED CONTRACT'OR'S DECLARATION Job Descri tlo
at !i2 1hembyafrmoharImnlicensWuodcrpmvisionsofCWpmr9fcommeming INSTALL PHOTOVOLTAIC pSiokEM
NI� with Section 7(1001 of Division 3 office Busi jssand PmfiaWons CWun
e, d my license�-� mranfnrm e X 3 ON ROOF.
ow V License CI s Lic.X G
Conuaa r
LL O nn RCHITECr'S OEC AT
'og 1 understand my plans shall he used as public record.
i a o O Licensed Professional
OWNER-BUILDER DECLARATION
uvi= 1 hereby M.that 1 am esempo from the Cimarm or'a License law for the
f-a< following mown.(Section 7031.5.Bmaress and professions Code:Any city or county,
F F O which requires a Permit to construct,alter,improve,demolish,or repair any stmcmrc
a3 Poor to its issuance.also requires the applicant for such permit to file a signed statemmeo --.--
thlt�gingratiated!pursWnttgthe pNvisiomof be Contractor's License Loo,(Chapmr9S Ft:,FloorArea•i - -,-. Valuation
(commericin wnh Senion.J000) fDivixionJof rhe Businrxs and PmfessionsCWc) X '(3"s i s ysq-a i
or tM1u['he it exempt oheiefrmm"and Nc basis for the vlledW bkemPtfod.AnY violation k"1' vi! tit !.�
-of not room
than
iv any dred o ll for apermit subjects the nppli<ano ora o civil pcnelty
nr two more than rive hundred enuarx(ssaol. APN Number ., ,,-h.�1-.•, Occupancy Type
ol,ax owner mime pmpeny,or my employees win wages as fact r sure=mr,camati.n, 304_ — ROUGH ELECTRI AL _
will do'ohe'..&.and'the'onamore'is'not'intended ror crooned for sale(Sec.70b, -'-"' "'--- -- -'- - -
'Business"and Pricfessions Code:The Contractor's License Law does not apply to an 501 - FINAL EIPF9�uT1$ ORO ctiEoKERGYi +,.
owne
r of m,ray Who builds m improves.herr..,and who does such work himself 505 - FINAL ELECTRICAL
r through Koeemployees.provided tlr t bimprovements tintended _. .....
Bcrcd fit If.however th building-or p i s Id th n r y f
,completN Whuman
improve
will the bart
roefp ng that he WIdo
mP room r l )
.. ... . _ ...-._ ....
0 1 u a of do
P pent em a cl siv IY t a 6 nb It tl tract m
construct the poiject(Sec 78 Bmineass and Professions Cod )The Connector's f ` s
License Law d oly o owner f pop ry who builds or mprows,thereon /(,
PP
and who countroacts.for such.put w,th alicensed,. ....m the.
Ciamoscam's License
Law.
0 pt sneer sec B'&P C to this moon
..net Data -
" WORKER'S COMPENSATION DECLARATION
^• „ . I h=rcby affirm under penalty of perjuD,nne of tha rollowing declarations:
❑ 1 have and will'mammin'a Certificate of Consent to wlf-incom for Workers
` Compcnamion, os Provided Por by Section 370) of he Labor Code, for the
_ performance of the work for which this permit A issued..
yppyyy��hale and will maintain Worker's Comiperviaiionrinsurpnce,as required by Section
- 9]IXI'o1aub lahor Cade;for the performance of the'work Tar which this permit is
iisurif:My Worker's Compedsatiun Insurance carrier and Policy number nrc:
Y ... a - _
.: Cart i H PolicyN .ISI-/�Oa7
f( CCR 1 ATION,OF EXEMPTION
. . _ FROMW RKE_RS
COMPENSATION INSURANCE' ----
11
--—
_.
"'
-
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(Thi.i xection nerd not 6c mmplered if the permit i.c for one hundred dollars
100)or It I
1 certify that in
h performance
of the 'ark for
this
permit
shall not employ any person in by mdnncr sd as m ec,;nw vbjciooii Workers
Compensation laws of California.Date _
-Application
-. .-._.__ _
NOTICETOAPPLICANT If, ft kSoh Carabe Exemption.you should
0Fcumewblthe Workers Caprv'sonshthcnbearmst
Q fortrh< inpliwith � hProvisamas orN his no shall bededrawakWal.
''s) x' l .s CONSTRUCTION LENDINGAGENCY '' I•V iP I ,
frombar him is.construction lending age.Yfo it performance
c
W r of tM1 kf -
Larder's Nami'.
5.' Lc dcrs Addresxl' n, I,.
•,,1 Mory that 1 have read this application and some thauhc above information is
W: cmreegl ogre=to comply with all city and county otdinsec
arms and ,a laws relating
Q'V tobuiliingconoroaion:undhcmny atvfimrixdr<prescnmtiva ofthis citymemcrupon ��
y1�i oho W ed P ,.Y f, Peet p rpo
't6.• IWeluen gtows ❑mdy and keep M1 1 the Cpof Cupertinoagmnst
.z Cit liabilities,judgments.c cr J e pence rich m y any y ,against sI d
L3 z City n con equ 1U th granting 1 oh ECO _
'AppY.IG\T WDERSTANDS AM1D,WILL COMPLY WITH ALL NON N'TI Issued by: r
SOURCE EG ATIONS. ?h 1 . .
S&aawmdhfAgIpl1ca dCo amt, -.'' - 1=,aj , Re-roofs /
:1 - AZARDOUS MATERIALS DISCLOSURE 1 '
wiva p �= t rt 'Idng bp tt nn dl M1x dm rat al, .Type of Roof
astir, cad by ove Correction Muroccpad CW e.Chapter 9.12.andthe Health andSfty t
CW S❑Y. 14-
0 All roofsshall be inspHedpct!edf l•ps n!o•l r�-toj al Sn\y rto-
ofng.matenal.be'i:ng mgtt
glled .
Will theapplicant o future
Wilding ceampontse co p t mrd x n=n If a roof Is installed without first obtaining an inspection I'agree.to remove
N
cm t hoz ous contaminant,t m nano.u defined by the Bay Area Air Quality Marg nt
Dict „ alt new materials for inspection Applicant understands and will comply with ..
❑ve. ,: ..-B;, IVm II*,, all non-point source regulations ..
_ ,.,,. _
.;1 halve read the heimdous gainers],reyuiremmu under Chapter 6.95 a"im
Colifomin Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently home a miutn.thin it ism,responsibility to amity the
occupant of ohb requi ents which must W'met prior to issuance ofd Cenificate of
OdcuPa y. -rt l.i ,,
_ " ,Signature of Applicant Date
All roof coverings to be Class `B"or better
_. .
- P, ='iOFFICE-