03070229 (2) CITY OFCUPERTINO ,'wAkxa=-i �`
BmLu1NCDIVIs1oN PERMIT �CONTRAGGTORINFORMATION t
BUILDING ADDRESS: ECOENERGIES INC IERMITNO03070229
ERS NAME: 171 COMMERCIAL ST PERMIT ISSUE DATE
LISIN PATRICIA H AND ALEXANIER03
F"'NE: (408) 746-3062 SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Oo LICENSED CONTRACTOR'S DECLARATION
w C I hereby affirm that 1 am licensed uncle revisions nr Chapter 9(commencing _ Job DBSCrIptI00
b with Section l t1 of Division 3 of Bic Busi d Professions C. '7
dmyliccnuis
•p o, in full force « L, ✓✓✓ YYY � , REVISION--IN HOUSE USE ONLY
j,QX_ License Class Y K Lie.as
;� Date�:n::3V Cantru NO NEW PERMIT ISSUED/ORIG. #03060195
qq _ :CRCHITECTS DEC TION
F 2 i I undcrstany plans shall M used as public rtcmds
JyU
mLicensed Professional
OWNER-BUILDER DECLARATION
i I 1 Wachy affirm that 1 am cumpt from the,Contractor's Liccnu Lew for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city it county
3which requires a permit to cnnnrucL alter,improve,demolish or repair any suuoture
-Zin poor m its issuance,also requires the applicant for such permit to rile a signed statement
¢ < that he is licensed pommunt to the Nevadans Of the Contractur's License Law(Chapter 9 Sq. Ft. Floor Area Valuation 0
d5p (commencing with Section IIM)[O of Division J of the B usiness and Proresions Code)or
$ that he is exempt tMmfrom and the basis for Bit,alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the gpplicatn a a civil prnalty of 3 3+?3I24hFacr0 0 Occupancy Type.
not more Nan rive hundred dollars($500).
I,as...or of the p elanty,ar my employee,with wages as their sole compensation,
will do ussurk,andthearmwer isnotinunded moffeted foxnle(S.C.7W,Business gip red Ip�p��g
and Professions Code:The Conuanot's License law aces not apply m an owner of 304 — ROUGH k:Li�(,'TR1E%' ?DS
progeny who builds or improve thereon,and who doessuch work himself or thinugh his
awn emptayxs,provided that such improvements arc not intended in offered for mile.If, 501 — FINAL ELECTRICAL ENERGY
however.the building or improvement ts sold within one year of compleuoq On owact-
builder will have BU,burden of proving that W did not build or improve for purpose of 505 - FINAL ELECTRICAL
mic 1.
❑L u owner of the properly,ser exclusively messand convecting with licensed cunv tor', t.
0 1.as the project(Sec.)Ossa Business end contrasting withCodc:)The d emactotil to
cense taw does not pply to in owner of progeny who builds or improve thereon.and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractoes
Luense taw, s�
❑lam tempt under Sec. ,BA PC for this meson \
Data
WORKER'S COMPENSATION DLCLARATION
1 hereby affirm under penalty of perjury one of the following declarations: '
❑I have and will maintain a Certificate of Continua self-insure for Workers Compen.
cation,as provided far by Section 37M of the labor Code,or the perfarmana of the -
work for which Nil permit is issued.
❑1 have and will maintain Workers Compensation Tomomet.as required by Section
37M of the Labor Code.for the performance of Ne work for which this permit is issued,
My Worker' nmpenselinn Insure cote rad Policy menterma:
Ca Poli o.�z 2�_
r. CERTIF CATEOFEXEM FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed If the permit is for one hundmd unit=(S I TO)
or Ice.)
I cenify Om in the pc,fumoumc of the work for which this permit is iuucd,1 shall not
employ any person in any manneru as to become subject to the Worked Compena0on .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should _
become subject to the Worker's Compensation provisions of dm Latin Code,you mum
'Z tral ith Comply with such provisions or this Nank shall LOU deemed invoked.
ti O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency lar the performance of
Y. ? she work far which this permit is issued(Sec.307,Civ.C.)
7.1 Lender's Name
z dimmers Address
C) I mnify Nu I Mve read this application and come that the man information is
1 F building I agree to comply with all city and county rutin of and sate laws relating I.
�U ahrovengeorisauction,ad hereby amhonprposeunwives of this city to enter Upon the
shove-mentioned progeny far inspersion purposes.
y (We)agree to ave,indemnify and keep hssmless the City of Cupertino against
r fA
[I bit incl menu,ensu and expense whichmgin any way accrue against aid City
Jz in eoriseq c fthe starting of Nis it.
^ APPLI UNDERSTANDS WILL C(jMPLY WITH ALL NON-POINT Issued by: - Dat
4 16�
50 EGULATIONS (///f/�{//ss'_� �O�O
Re-roofs
Sig tureor ApplicanBCo,vactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will LOU applicant or future building Occupant store or handle hanrduus material
m dermed by the Cupeninn Municipal Code.Chapter 9.1x,and the Hcalth and Safety
. Arses 23,3x(,)7
❑ All roofs shall be inspected prior to any roofing material being installed.
Ye
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
COLO hazardous air conmalmams as defined by the Bay Area Air Quality Management all new materials for inspection.
Dimric0
❑Yea /r1Tlu
I have. a INtan,,materials aquiamrnu under Chapter 6.95 of the Cali foo-
ria Hcalthgt et ah,Seeuons25 ,25533 TOO 25534.I understand thin ifud Wilding
doesnot c e have a unan4 it re risibility to today the occupant of the
require which mum el I. an oracrniarateo -p,ayO Signature Of Applicant Date
J ro
Owner or awhorired agent pmc
All roof coverings to be Class"B" or better