04040171CITY OF CUPERTINO a
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BUILDING DIVISION Pr,RMIT
BUILDING ADDRESS:
1118-6 SYCAMORE CT
AKEENA SOLAR
PERMIT "004040171
OWNER'S NAME:
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PERMITUZUEDATE
Ok MIKE MULLIGANUNIVERSITY
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SANITARY NO. CONTROL NO.
(408)867-0558
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
I hereby I licensed under of Chapter 9 (commencing
Job Description
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off rm that am provisions
witl�eciigJ.]gYJ7 of Oivision3 of UC Business ntl rufessions Code.andmylinmeeis
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inrlilit and effect flbB T;`'3
INSTALL SOLAR PANELS
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License C41"a.
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ARCHITECTS DECLNRTI-D�—
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Licensed Pn�fcsl
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Corawtor's License Low far the@�fi
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i following reason. (Section 7031.5, Business and Professions Cndc: Any city nr county
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i which requires a permit to construct, alter, improve, dcmrlich, or repair any nmcmrc
' prionuitsiuvance.alsureyuirestheapplicamlursuchpermiuoRleasignednamment
Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant m the provisions of the Cutaneur's License (Chapter
(commencing with Section 7XXEof Division 3 of the B usiness and PrahmaAnm Code) or
B that he is exempt therefrom and the basis for the alleged exemption. Any violation of
34>`5I7fQlaiffl3e100
Occupancy Type
Section 7031.3 by any applicant for a permit subjects Ne applicant to a civil Penalty of
not more than five hundred dollars (5500).
.
❑ I, as owner of the property, or my employees with wages as Noir sole compensation,
Required Inspections
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will do Ne work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Cade: The Correlation's License Law does not apply to an owner of
9
- property who builds or improves thereon, and who does such work himself or through his
own employees, p,.video that such improvements are net !pleaded or offered for sale. IL
however, the building or improvement is sold within one year of completion, Ne owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale,).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li.
cense Law does not apply m an owner of property who builds or improves Ruman, and
who contracts for such projects with a cnmreclor(s) licensed pursuant to the Contractoh
-
License L.
❑ 1 am exempt under Sec. . B & P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby ai fam under, penalty of perjury one of the following declarations:
I have and will maintain a Cea home, of Consent to self-inauR for Workers Ceram.
sation, as provided for by Section 3]00 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I ban and will maintain Worker's Compensation Insumnce, a required by Section
3]00 of w Labor Code, for be perfmmanee of Ne work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy mmnher�re� 05
Carrier. 5 rry( NM Policy No.: I VJ''1 0
CERTIFICATE OF EXEMP'fW FROM WORKERS'
COMPENSA O INSURANCE
(This Section need not be completed if the Permit is for one hundred dollars pi 100)
or lose.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any Person in any manner an a to become Subject o the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificem of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
Y forthwith comply with such provisions or this permit shall he deemed mankind.
CONSTRUCTIONreiniLENDlNGAGENCY
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hereby rte Net there issued(Seaconstruction0 ending agency for the performance of
-
which
the work fur which this permit is issued (Sec. ](57, Civ. C.)
Lender'sName
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Lender's Addle Addreu
1 ccnify Net 1 have rand this application and slow that the above innowedun is
correct. l agree to comply with all city and county ordinances and state laws relating to
building cwarrom ion, and hereby emh.rire representatives of this city to enter upon the
above-mendoaed property for inspection purposes.
y (We) agree to save, indemnify and keep harmless the Cl ty of Cupertino against
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n liabilities, judgments, costs and expenses which may In any way accom against said City
z, in consequence of Ne granting of this pSrmiC
—t APPLICANT UNDERS NDS.AND WILL COMPLY WITH ALL NON.POINT
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Issued by: D e
SOURCE REGULA P /
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Re -roofs
Type Of Roof
ignamrc of pplicaHAZARDOUS MATERIALS DISCLOSURE Data
Will Ne applicant or future building Occupant store or handle haaaNaus material
as defined by the Cupeni an Munici pal, Code, Chapter 9.11, and the Health and Safety
Cade, Section 35532D)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applies., or future building occupant use equipment or devices which
.niI hazardous air contaminants as deft red by the. Bay Arca Air Qua] ity Management
all new materials for inspection.
District] /
❑Yes J Na
I have read Ne hazaNuus;F ais requirements under Chapearb 95 Df thc Callar.
ria HealNffisafm'Code,secdynSZ5N15,15533and25534.1unde,s.dNotif Nchuilding
does n t cunendy w a lefiant, thin it is my raspo'sibility m nottly the Occupant of the
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regw emtwh 'ustbeme( pdart.1!11 ance.aCanlficam.fOcaPan
Signore -fApplicant 'D to
L7o aa
All roof coverings to be Class "B" or better
Owner or an th.riecd anon m~