06110101 77
CITY OF CUPERTINO ., >"" ' <
BUILDING DIVISION PERMIT CONTRACTORINFORMAT=ION
BUILDING ADDRESS: MC SOLAR ENGINEERING PERMIT NO.06110101
1.1.00
ER'S NAME: PERMIT ISSUE DATE
CHRISTOPHER MIGDAL 2362 WALSH AV12 /01 /2006
PHONE: SANITARY NO. CONTROL NO.
(408) 496-6226
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
soca LICENSED CONTRACTOR'S DECLARATION Job Description
wF 1 lemby ef'on that 1 am 1lanscd under pmvivo.of Clupter 9(commencing P
:Zmy with Section7IXIU)of Division Jaf de Business and Prof.siuns Code,xnd mYliccnseu
inflif aneerz 3 INSTALLATION OF PHOTOVOLTAIC SYSTEM ON ROOF
a Liansc Chas�_Lk.N
•P,o Dam /� -/--r !. Conuanar
'�'Js ARCHITECTS DECLARATIO i s ` J
i ad I understand my plans shall the used u public reeems
idD
°oG Licensed Professional
5 OWNER-BUILDER DECLARATION
I bcrchy affirm that I am exempt from Ne Contractors License Law for the
p o following resume.(Section 703 1.5,Beat..and Prefessio.Coda:Any city or county
i m which neq.1.a permit In construct.alma,bnprove,demeluh.or mink any structure .
a prior to in usumm.also mquims the applicant forsuch permit to rile a signed statement
C that he is licensed purwanttodue pmvismnsofNcConuxmr'sI-iemmLOW(Chapmr9 Sq.Ft. Floor Area Valuation
`teF$ (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or $17550
_ then he is exempt therefrom aM the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Oc applicant o a civil penalty of APN Number Occupancy Type
not more dean five hundred dollars($5M),
❑I.in owner of the property,or my employees wide wag.as their side compensation,
will do thc work and dee structure is hot intended or offered for sale(Sm.7W.Businw B425600
Required Inspections
and Prefeaaions Code:The Contractor's License law da.not apply he in owner of q P
propeny who Wilds or improve Nunn.and whodocssuchworkhimselfor through his
own employe.,provided dist such improvements art matin anAM proffered forsale.If. -
however,me Wilding or improvement is sold within one year ormmpletien.Ne owner-
- builder will have the burden of proving Nat M did not Wild or improve for purpose of
sale
1,in owner of the property,am exclusively contracting with licensed contractors to
construct dee project(Sec.7044,Business and Professions Code:)The Couaumr's Li-
cunc law dpan not apply ua an owner of property who Wilds or improv t1¢mon,and.
who concocts for such projects with a contrecmgs)liecomd pursuant to the Contractor's
Lima.Law.
❑1 am exempt under Sec .B&P C for On nation
Data
WORKER'S COMPENSATION DECLARATION
I thereby affirm under penalty of perjury one of the following dalerxuau:
1 have and will maintain acertificam or Continuo mir-imam for WorkcYs Compcn-
uuon.in provided for by Section 3700 of the Labor Code,for dee performance of the
wart for which On permit is isned.
1 have and will maintain Worter's Compensation Insurance,as tequimd by Section
00 of tie labor Cattle.(or the performance of the wart for which this permit Is issued. '
My Werkars omp�nam.In. mvmd Policy number -
� '
Cartier. �' _]Y[ O EXE policy No.;
CERTIFICATEOMPE EXEMPTION FROM W FANO K S'COMPENSATION INSURANCE ,
(Thu section need not Im completed if the permit is foroac hundred dollars(SIM)
or less.) -
I eenifv that in the pearommanee of the.,it for which this permit is issued.I shell not
employ any person in any manner as as an become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making On Ccnifiae of Exemption.you should
become subject 0 the Workcla Compcnsuion provisions of tha labor Code,you mut
.JO foMwith comply with such proviuons or Nu permit shall W dccmed mated.
ZV; CONSTRUCTION LENDING AGENCY
F•m I hemhyarfirm thmthere iso memmednn lending age.,forthe runfuniamcxuf
E
that worst fur which this permit is usued(Sec.3097.Civ.Q
1 A Lenders Name
,= z lenders Address
U Q I certify that 1 have read this application aral sum this do above information is
LL corms.I agree to comply with all city and county eminences and aim laws relaung to
QU building construction.and hereby authorim npreacmifliveS mthis city to enter upon the
r a
above mcjudgadpmperty for inspection purpowhich m.
(We)agree to save,indemnify and keep harmless the City of Cepcnino against
inmii creacogmcn¢coatsandof this uwhich may in any way carne agunstuid City
V z A PLICANIT of Negranting SNis pumll.
'—' APPLICANT UND RSfANDS AND WILL[OMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REG ONS. "
f1 2 Re-roofs
Side of ApplicanuCanuanor Date
HAZARDOUS MA AIS DISCLOSURE Type of Roof
Will the applicant or future building occupan.tore or haMlc henamous material
in defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety '
. ❑Y.Section 17Va1.
All roofs shall be inspected prior to any roofing material being installed.
LS'fJa
WiI1 dee applicant prlaTTmm building aaup un use cquiprocat or dcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
emit bayamons air comamm ns u derived by the Bay Area Air Quality Management
District? all new materials for inspection.
❑Y. Nu
I have read!the hexa Pte,manuals requirements under Chapin6.95oftheCalifor-
niaHealth&Safely Cadc,Sections 25585,15533 and 25534.�AcnmM dutifthc Wilding
dos sat currently have a tenant Nat it is my resource to modify tbo occupant of the
mp,manc iw ' hm.s .t � taw rrbc`c fwamoraropamy. _ Signature of Applicant Date
x
All roof coverings to be Class "B"or better