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03100163CITY OF CUPEIMNO C RMATION BUILDING DIVISION PERMIT NTRACTnRIN BUILDING ADDRESS: - 11681 TIMBER SPRING C.T AKEENA SOLAR PERMIT N`03100163 R'S NAME: 605 UNIVERSITY AVE PERMIT ISSUE DATE ICHAEL WIESE 10/22/2003 PONE: (408)867-0558 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am limned under provisions of Chapter 9 (commencing P with Section) ) of Division Sof NC Rusintus and Professions Codc,and myliccdc is mmn rnmer�a SOLAR PANEL FINALED Liccnu laza LIT. X �S--f�3 s ' Dole carom ARCIIITE LARATION DEC 2 9 2003 - I understand my plana shall he use puthimmeorda Licensed Professional OWNER BUILDER DECLARATION BUILDING 1 heraby affirm ,hat I am aemp, from the Contractors License Law for IW following reason. (Seedun 71D 1.5, Business and Professions Code: Any city Of county which requires a pdmlil to Consumer. alcor, improve, demolish, or repair any structure $13300 prior m its issuance. also requires the applicant for such Permit to It IC a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to provisions n(the CommctoCs License Law (Chapter 9 (commencing with Section 7(M) of Division 3 of the Business and Professions Code) or 36654085.00. that he is exempt therefrom sod the bazts for the alleged exemption. Any violation of APN Number Occupancy Type Section 7071.5 by any applicant for a permit subjecu the epplicanl to a civil penalty of not more than five hundred dollars ($500). ❑ I,M.inner of the property, or my employees with wages as Limit in compensation, Required Inspections will do the work, and the summon is notinmoded or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License law docs no, apply I. an owner of property who builds or improves thereon, and who dues such wort himself or through his own employees, provided that such improvements see not intended or offered for sale. IL however. the building or improvement is sold within one year or completion. Ne owner, builder will have the burden of proving that he did not build or improve for Purposes of salt.). I, as owner a( find property, am exclusively contracting with licensed cunmmon to Crnstrun the project (Sec. 7(N4, Business and Pro(cssia s Cade:) The Contractor's U. cede law docs not apply to an owner of propeny who Wilds or improves immon. and, who contracts for such projects with a contractor(s) licensed pursuant o the Convector's License Law. 1 am exempt under Sec. (( t ,B&PC Ior thh reason r J:a�i�+'iE�[t Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury One of Ne following dochra,ions: ❑ I have and will maintain a CeniOene of Consent o Ml6insum for Worker's Compen. sation, as provided for by Section 37011 of the Labor Code, far the performance of the work for which this permit is issued. ❑ 1 have and will maintain Wurkces Compensation Insurance, As required by section 3700 of the labor Code, for the performance of the work for which this permit is Issued, M Work Co penia' Insure c comer end P1olity, number arq Z2 �W mer: Pau �a, l $ 3 CERTIFICATE OF EXEMPIIONy OMOM Flt WORKERS' COMPENSATION INSURANCE (TTlsseclon need not M completed Bthe Permit is foram hundred dollars ($IRB last.) I ccnify that in the perr,,...A of IW work for which this permit is issued. I shall nu, employ any parson in any manner an az m become subject to the WarkerY Compenuuon Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this CeniOcate of Exemption, you should become Subject to the Worker's Compensation previsions of the Lahor Code, you must forthwith comply with such provisions or this Permit mall Ac deemed nwoked. _ CONSTRUCTION LENDING AGENCY 1 hereby 31Brm that there is a domination lending agency for the Performance of to work for which Nis permit is issued (See. 3097, Civ. C.) - Lender's Name Lender's Addmas 1 certify Na, l have read this application and grate that the above infomladun is ' correct, 1 agree to comply with all city and county ordinances and $talc Iowa milting to building ConsWction. and hereby amhorim mpresentstims of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree ,r an, indemnify and keep harmless the City of Cupcdino against ' Iiabilides. judgmenu. costs and expenses which may in any way accrod against Mid City inconx ad of,hc 6nmingt1i,rmit. .c 6APPLICA NDERSILL COMPLY WITH LL ONPOINT Issued by: Date V SOURCERE Re -roofs Type of Roof () 2 p Pill p IICaHA2 "Dor MATERIALS DISCLOSURE Data Will Ne applicant or future building occupant store or handle havudous material As deRnad by the Cupertino Municipal. Code, Chapter 9.12, and the Health and Safer, �. Semon 25532(0)? 1 All roofs shall be inspected to any roofing material being installed. ❑Yes )END prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant aM equipment or device, which con11 haMrdous air contaminants ae defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes I nave real tit WraNlms malt els rtyviremcnts underChapler69So(the Califon Iia Health&Safetyc Sade CTS 25533and 23534.1 umkrsuM Nwif the Wilding does not C.Dooml, Iona �thm,ls ) PaminllltyID d(y the copam rl the required awn(h c •,pfi wissanc ncemncat C.Parev I Signature of Applicant Date All roof coverings to be Class "B" Or better 0wner Y o' a wd tib ret Date )ceZ 100 W iZLu DZ ) �HLL, f 2 edu )yU 0 w :tea n rn .a �ai Q 0 w- utn -? a :xq F - CITY OF CUPE BUILDING DIVISIONSION PERM Q077 BUILDING ADDRESS: 1168 TTM_RF_R SPRING CT AKEENA SOLAR PERMIT NcO 3 10 0 16 3 OWNER'S NAME: 605 UNIVERSITY AVE PERMIT ISSUE DATE MICHAEL WIESE 10 22/2003 PHONE: (408)867-0558 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 709,0) of Division 3 of the Business and Professions Code, and my license is in fell force a cr�ct. 5S 3 License Isis L SOLAR PANEL Date t -a Contra. r I��CPo snLl `- ARC H ITEARATION I understand my plans shall he used public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7011.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure $13300 prior to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 36654085.00 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type P Y YP not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work• and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not Wild 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 Code:) The Contractor's Li- . cense Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Scc. . B & P C or this reason r Owner 4� Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Cumpen- sation, as provided for by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3710 of the Labor Code, for the performance of the work for which this permit is issued. My Work ' CogtLpensa . Insure ce carrier and Policy number a rricr. 'i"C� Policy N Lil�-zZfD CERTIFICATE OF EXEMPTION�M WORKERS' COMPENSATION INSURANCE (Ibis section need not be completed if the permit is foronc hundred dollars (Slop) or Icss.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: !r, after making this Certificate of Exemption. you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 1097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorim representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabilities,judgmcnLt, costs and expenses which may in any way accrue against said City e granting oft is permit. ERST WILL COMPLY WITH LL NON -POINT Issued by: Date (� N . Re -roofs Type of Roof PM m/C for DatcHAZ RDOUS MATERIALS DISCLOSURE icant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely Code. Section 25532(a)? l "g[JJo All roofs shall be inspected to any roofing material being installed. Yes prior r If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? E] Yes I have read th ha)ardouI ls requirements under Chapter 6.9So(IhcCalifor- nia Health & SafctyC 5.11111-1 25534.1 understand that if the building dces not currently icna IS esponslbillly to duy the occupant of the reyuirem is wh h iss ane f a Certificate Occupant . Signature of Appl ieant Date �V All roof coverings to be Class "B" or better � Owner Datc o u real a nt a CITY OF CUPERTINO 'ITY OF CUPERTINO PERMIT APPLICATION FORM APN # G Date:',. Fee Group BAPPLOTHER Building Address: 11 6001 6 z Owner's Name: Phone #: BUILDING -) Contractor: k License #: BBOILER2 _' Contact: Cupertino Business License#: Boiler > 500K to 1M Btu 42— Building Permit Info: B 919 ❑ Elect K Plumb ❑ Mech ❑ Jo Descriptioril `` Resi tial `i "C�rxiil�®rc�'a1 El S t. Floor Ar i $/Sq.Ft.: Cost of Project: ' ,. Occupancy Group: — 00 � _... Type of Cons ion: BUILDING BCONSTAXBQ Con. Tax for BQ Zone Quautity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 'ITY OF CUPERTINO �PERMIT APPLICATION FORM CUPEK FINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING r BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 "ITY OF CUPERTINO n of CUPEI�fINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BRENIREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rrndl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING �a....m°BSPECIAL Ins ection BUa,DING BSWIM -Special Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERAUTFEE Mech Permit Issuance MECHANICAL PPERNUTFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3