03060195 CITY OF CUPERTINO 'ne(x a .e ^r
INFOR
BUILDING DIVISION PERMIT `CONTRACTOR MATION sR
BUIL DING ADDRESS: ECOENERGIES INC PERMITN003060195
ER'S NAME: 171 COMMERCIAL ST PERMIT ISSUE DATA
)NE: SANITARY NOCONTROLNO.
(408) 746-3062 .
AR CHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMF.CH
X 00 LICENSED.thatAm Ii CONTRACTOR DECLARATION Job Description
w I hereby ef0rm that 1 em liconsed unJer visions of Ch m'
Y(commencing P
with Sc , Bnf Division 3 of NCBusin ProfcssinAs Ca de.and my license is PO
-ow in fullfo,g,nest
,E3 ueen:ce�'9 see.. Z 39 . SOLAR PANEL SYSTEM uV���* �
Da¢
ARCIID"ECTR
AUG y 99
I aunt mypiwamul Muudupublicme.mdA J ZOO,J
JyU
a05 LiccnseJPmfcssional Bull— t.
Oat I Am exempt
from
DECLARATION
COO 1 masa affirm that 1 am exempt from Ne Contractors License Law for the 4/�I o
<COO C followinguires a.(Secdun 703 1.5,Business and ve.dm i oli Code:Any city s county
$v` which its lira a permit m,cnatruct,alcor,improve,h permit t ore pair any structure
� poor that he is
canted e.also puersamgo theres theapplicant(be sucCompactors License
eLw Cammem
EZOthal he isccgwith Section 7")of Division of
Contractors (ChapterCode)or Sq. Ft. Floor Area Valuation
e F (commencing is exe pt therefrom
And the
Division of the Business and Profession Any vi Csylc)ur
y�$ Nal he is exempt thertfrom and dre pssis for the alleged exemption.Any violation of 35932051 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mum man five hundred dollars($500). P Y YP
❑I,uownerofthepMpen OrmycmPloycuwithwagesumciraolecompenution,
will do the work and the anoctum is not intended or offered focaato(Sm.7041,Business _
and Professions Code:The Conluorm's License Law does not apply m an At,of Azukns
prapeny who bunds or improves themun,and who doessuch work himselfor through his 501 - FINAL PORTETT ENERGY
own employ=.provided that Such improvements are not intended or offered for role.If, 505 — FINAL ELECTRICAL
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving mat he did not Wild or improve for purpose of '
sale.).
❑1,as owner of the property,am exclusively convecting with licensed contractors to
construct the pmject(Sec.7144,Business and Professions Code:)The Contractor's Li.
come law does not apply to an owner of PrOpeny who Wilds or improves menton,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractors
Lice Are Law.
❑1 Am exempt under Sec. B&P C for this mason
of Dam
WORKER'S COMPENSATION DECLARATION
--1 hereby AM.under penalty,of perjury ane of Bre following declatstiom:
I have and will mainuin a Certificate of Consent to self-m3um for Wor1mr's Compete
ration,As provided for by Section 37W of the LAWr Cade,for me peffamanm of the
woh for which Npermit
is is issued.
❑I have and will maintain Workers Compensation Insuran¢,n mquimd by Section
3700 of the labor Code,for the Performance of me work for whi this Permit m iuued,
My Worker Comperommi n uralsce cartim and Policy nu am:
Cion, $'7iro'E PolicyNo.: 7zZS2a
�(J CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seelinn need nor W cump1cwd if the Permit is for one hundred dollars($KU)
or les.)
I coni fy that in the performance of the work for which this Permit is issued,1 shall not
employ any persnn in any manner an As In become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifrcate of Exemption,you thou lJ
Wcame Subject to the Wohcr'e ComrocWion provisions of the labor Code,you mum
.,O folAwirh comply with such provisions or this Permit shall Inc Almond!revoked.
z '-s CONSTRUCTION LENDING AGENCY
C7
[+ khereby which thi thnd¢reiu comSee 3W ,Cre. agency for the perfurmaoce of
�i me work for which this permit b issued(Stt.]097.Civ.C.)
(A F
Lender's Name
= z Lenders Addfeu
U Q I certify that I hale mad this application and sum that the ahem information is
D. ^F conn.I agree to comply with All city and county ordinances nd sure laws mlmot to
0 Wilding construction.and hereby suthonn,representatives of this city to crier upon the
4 abovomen Toned property for iospcction purposes.
(we)agree to save,indemnify and keep harmless the City of Cupertino against
r h
thatICA,judgments,costs and expenses which may in any way accrue against mid City
U in conuyucncc of morin,of this per it.
APPLICANT STANDS AN ILL MPLY WITH ALL NON-POINT Issued by: Dat 1
SOURCE R TIONS,
3 �
Re-roofs
gig to of rau
Applicant/Conctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hammuuua material
As donned by to Cupertino Municipal Code,Chapter 9.12,and the Health end Safety
A
.Section 33372(1)? All roofs shall be inspected p ler to any roofing material being installed.
❑Yes
WIII the applicant or Nub", g arupantuse equipment ordcvica which If a roof is installed without first obtaining an inspection,I agree to remove
incurious Air comanno d by the Ray Area Air Quality Management all new materials for inspection.
ic0
❑Yes ❑
I have mad me hara do,s materials requirements under Chapter 6.95 of me Calder.
calN&Safi ,Smdmu 50$.35533 and15534.Iundcfsundthatif Nthuildmg
n l cu tl w a vena mat itsu my mspoaibility m sou da:occupant of me
irem lcnmumW et '/n'y/rW/�rss�uan� mof.Omfsamof n er. Signature of Applicant Date
ser or authorindagent [�/"k1 � All roof coverings to be Class"B"or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRCT®RINFORMATI.
BUILDING ADDRESS: ECOENERGIES INC PERMIT"°03060195
OWNER'S NAME: 171 COMMERCIAL ST PERMITISSUEDATE
1.TSTN PATRTrTA T4 ANT) TAT.T7.XATZ FR "/?
PHONE: (408) 746-3062 SANITARY NO. CONTROL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
foo LICENSED CONTRACTOR'S DECLARATION' Job Description I U 1 hcreby.frima that 1 am licensed under visions of Chapter 9(commencing p ,lk @
nab with Section IlufDivisisa3arNCBuaines�Professiuns Code,andmyliceotais
:�3 u«;° ns, r ( uC.g 2 - SOLAR PANEL SYSTEM AUG
Da¢ 1 Cunvmt 7, ^003
asap ARCHITECTS° RATION
E ,I sand my plea shell he usoed a public records
Jy
sat Licensed Pmfcuionel - 11'1 '�^
G OWNER-BUILDER DECLARATION U/ LD
I I heathy affirm that I am exempt from she Couractoh License Law for the W
MC fallowing rtasnn.(Satian 7(D 1.5,Busimm and Rofeatinns Cale:Any lily ser County
which mquires s permit to court site,improve,demolish,Or repair any structure
poor to its Waseca.also residuesthe applicant for such permit to rile asignctl statement
xxC that he is licensed pursuant to the previsions of she Contractor's Licarms,Law(Chapter 9 Sq. Ft.Floor Area Valuation
F (commencing wi sh Section TOM)of Division 3 of the B usineca and Profeulnm Code)it
$ Not he Is e.empt therefrom and the basis for the alleged c.empdoo.Any violation of 35932051 . 00
Section 7031.5 by any applicant for a permit subjects Ne applicant to a Civil penalty of APN Number Occupancy Type
not mon than five hundred dollen($500). p y yp
❑I,as owner Drum properly,an my employees wish sages u their sets compensation,
'will do the work,and the swcmre is not intended oro@rid fo...Is(Sec.7044,Business _
and Pmrections Cade:The Contractors License law docs not apply m an owner of ns
pmpeny who builds or impioes dareon,end who doessuch work himscHar through his 501 - FINAL ELECTRI AL ENERGY
own employees,provided tint such improvements an net intended conflicted for sale.If, SOS — FINAL ELECTRICAL
however,the building or improvement is sold within ore year of s o ndedon.Ne owner
builder will have she burden of proving that he did nut build or improve for purpose of
ate.).
❑1.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70x4.Business and Professions Code:)The Contractor's LF
conn Law dors not apply to an owner of property who builds or ire proves themon,and,
who contracts for such projects wish a contrntorls)licensed punuent to the CanraClu(i
Lmnm Law.
❑I am caempt under See .B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby Linton under penalty of perjury rim of the following deCluuimn:
k]I have and will maintain a Certificate of Consent to seH-Inmm Worker'.
for Camper.
diol,u provided for by Section 37M at the Labor Code,for the pesrarmeme of the
work far which this permit is issued.
❑I have end will maintain Worker's Compensation Insurance,m required by Section
3700 of Ne labor Code,for doe Performance or the wart for wh'� Nis permit 1.issued.
My Worker Cmarrannation/1psu�nce artierend Paliq nu are:
Cgrtiy,.J��//E I�s'v� Policy No.:
�(J CERTIFICATE OF EXEMPTION FROM WORKERS'
I COMPENSATION INSURANCE
(Thts section need not be completed if the Mmmit is for om hundmd dollen(SIM)
of Ica.)
1 cenify Nat in the performance of she work for which this permit Is Issued,I.hall not
employ any person in any manner so u m become subject to the Work us'Compcnsallon
Laws of California.Date
Applicant
Nf1TICE TO APPLICANT:If,Offer meting this Certificate of Eacroption,you should r
become subject to use Worker', La
Compensation provisions of the Labor Code,you mus
.J,Z fonhwish comply wish such Provisions or this Permit shall be deemed naked.
Z O CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that Nen its construction lending agency for the performance of
Cl ti d.work for which this permit Is Issued(Sec.3097,Ci,C.1
W� Q Lenders Name
Z) z Tondos Address
V 0 T certify Ns I have read this application and sum that the above information is
O (~
correct.l agree to Comply wish all City and County ordinances and state laws slain,to r
V building construction.and hereby authorize representatives of this city to enter upon do
r U ahovo-onemiomd property Tor inspection purposes.
(WO agree to ave,indemnify Lod mors aml
hamlets ft City of Cupcninoagainst
rFih Iiabllities,judgments,costs W eapensu which may in any way accrue against mid City
V Z in eonseymnee of raising of this reign.
^ APPLICANT D STANDS AN ILL IMPLY WITH ALL NON-POINT Issued by: Dat
SOURCE R TONS.
A���a
-V Re-roofs
Si rc of ApplicanVCmanctor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant Or future building cceupans smm or handle hemrdous material —"
as defined by the Cupertino Municipal Cods,Chapar 9.12,and the Health and Safety
Code,Se❑cYu 25532(a)? All roofs shall be inspected p�orrlor hoofing material being installed.
Will the applicant or future busi
ng occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
mu haramous air mnamimnts CB d by the Bay Arta Air Quality Management all new materials for Inspection.
Tadct?
❑Yes ❑
it l have read Ne hamrdous materials requirements under Chaparti.95 attic Cellos,
nm HcalN&Sof yEbdc,Sccdor 505.25533mdU534.1undcnand NaGf Nulmilding
door not cu dy lhve a tone (iNat Isti,my responsibility m nau Nc moupant ofNc
mquinm nGC,muni sopa „r Imaanmo(eccnineaatr a CX Signature of Applicant Date
nor or aumomcd agent Dow All roof coverings to be Class"B"or better