08020167 CITY OF CUPERTINO "`� •':'
BUILDINGDIVISION PERMIT �' k�• '(1 ,�N. ' TZ'
amLQlrgGpQDMAI AVE SOLARCITY P08020167 .
WNEWS NAME: PERMITISSUEDATE
JOHN & MARGARET STUBBELBINE 393 VINTAGE PARK DR STE 140 03/13/2008
ONE: SANITARY NO. CONTROL NO.
(650) 638-1028
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
I� o s� I�
Soto LICENSED CONTRACTOR'S DECLARATION Job DOSCrIpIIOn
Z Iion7 a)ofDivnlanftheBuiorder
ssandPialounfsCode. 9myliceoingnseis 6KW ROOF FLUSH MOUNT PHOTOVOLTAIC-PAINT FLASHING
<
with Section Ok0 nfDivlalon3oftha Eualnw and Profwiuw Code.and mylicemeis
°Ow tomangand
� z Lkenm w Lle.g TO MATCH ROOF COLOR PER PLANNING.
3 Deu Commissar DECLARA�'j
IO
ARCHRBunderstood5i 1 understood my plana MN bo used As public rtcorN
e U
y cad�a
Licensed Professional
3 OWNER-exaDER DECLARATION
1 mashy.(Timm that 1 I.S.cxampe from the Cashom Co Cleaner Low o for Ne
O O following mason.(Sectio RD 1. s,Business and are.der li Code:Any city or county
$ whichrequiresits u•e,also re cnnmucL alar.impmw,h pe m it I ri repair any cut
mare
prior to its iuuenee.Blau requires the applicant for such permit fileasigmd wumcnl
x�
that bo k licensed pursuant to tire provisions of We Contractor's Lmmoc Law(Chapter 9 Sq.FL.Floor Area Valuation
30000
F-$ (commencing with Section 7000)of Division 3 of the BBusinessAnd Profusion&Code)or
Q 3 that he k comps therefrom and the bask for the alleged ecemptim.Any vloladm of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty ofNumber Occupancy Type
not more Wan five hundred dollars(5500). 3 6 2 0 5 0 2'1�bT.
❑1,u owner of the pmpem w my emplaycu with wges u thm mla eampeflon,
will do thework,and thesmsmure is notintenled monered fmmle(Sm.7 .Buenw Required Inspections
-
And P orealou Code e ns The Contractors License taw does not apply 0 an owner of q p
property who bund,orimpmw themon,and whodeeacuch mri himselforlluough his
awn employes,provided that such improvements w nainundM orORered formic.If.
howevv,the building or Improvement Is sold within ane year of completion.doc owner.
Wilder will have des borden of proving that bo did not build ar improve for purpo n of
nk.).
❑1,as owner of the property,em exclusively conksming with licensed contractors so
construct We proleet(Sec.7044.Business and Profession Code:)The Contractors Li.
ounce law does not apply to an owner of property who builds or improves thereon.and,
who contacts for such pmleets with a eommetar(s)licensed persons,w the Contractors
License Law.
❑I am exempt under See .B k P C for this notes
ner Dau
WORKER'S COMPENSATION DECLARATION
I hereby afErm under pully of perjury au of the following declarad.u:
❑1 ham and will maintain a Cerdficam orconaenl to self-amuse for Worker's Compeo-
wire,as provided for by Section 3700 of dre Labor Code,fm the perfomnme of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Iuuraue,As required by Section
3700.17 the Lab"Code,for the performance of the work("which this permit It Issued.
My Workers Compound..ie..carrier and Policy number am: '
Cartier: rl!IQ4 Policy No.:Cv7CX77dy/2F7 l
GORTIFICAM OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThOssee lon need nutbocompiemd if the Perch la forma hundrW dollars(SIM) -
orlea.)
1 coni[that in the performance of dm work for which this permit is mood.I ahall not
employ any Person in my mummer an as to beeoma subject to the Workme Compuwmon
Law of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Comilla ,of Exemption,you should -
beeome subject m the Worker's Compensation previsions of the Labor Code,you most
., forthwith comply with such provision or this permit shall W decreed revoked.
Q .
z CONSTRUCTION LENDING AGENCY
[-m I hereby alarm that Vert is a construction lending agency for the performance of
pi the work for which Wk permit is intrad(See.3097,Civ.C.)
6Wi Q Landers Nene ,
] z Lenders Address
U Q 1 sonify that I have mad this applmmon and suis that We above informadun Is
U, :'! cooem.I agree to empty with all city and county eminences and su c laws relating In
DSV': building eonmuction,and hereby Authorize mprexnts0ws of dis city to man upon the
Lf7 allow-menti.ned property for inspection putp"d.
py (We)agree to save,indemnify ad keep harmless;the City of Cupertino against
,,,I fzag
liabilities judgments,costs and expenses which may in my my scene against and City
in
V^+ APPLICANTAND thisof do groating of permit.
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCERECULAn — S—
Re-roofs
ianwrtof Applicen�A_RDOUS MATERIALS DISCLOSURE Da Type of Roof
Will the applicant or future building ocaupanL.W.or handle havudow mwrial
n defined by the Cupertino Municipal Code.Chapter 9.12.Arm the Health and Safety
ode,Semon 25532(,)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes AIN.
Will We applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,.emit haurdnw car conuminnu a dcflmd by the Bay Arca Air Quality Management all new materials for inspection.
Dianict7
❑Yes �\
Its mal the hasmawm.Lfkk mquimmcnuuivtr Chapurd,95 of the Califor-
nk lka["SalcLyCoda,S=ts M25505.25533 am125534.1.Wcw.WWuJf the Wilding
dew not cmrcndy hew a unanL Wt II b my supamihilily to ratify du.eccupant of We
omuimments which most W metpriorm issuance ofa Ccoifmau of tic wry. U Signature of Applicant Date
owncr"anth.rimd agent 1 D All roof coverings to be Class'%¢"or better