08060107 CITY OF CUPERTINO r < Ayw+�r 4a e " 'e7
BUILDING DIVISION PERMIT CONTRACTORINFURMATIFIN '
PERMIT NO.
BUIL�TC}9pDJ1R WESTSHORE CT REGRID POWER 08060107
WNER'S0'I MLE: PERMIT ISSUE DATE
BARRY GREENE 1624 DELL AVE 06/24/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
300 LICENSED CONDUCTOR'S DECLARATION Job Descrl non
m 1 bcrtby affirm that I am licensed under provisions rf Chapter 9(mmnnomrg P
-Z wiNSedon7")afDivWon3afd¢Busine dProfessiauCo .-m—ylkenseu ADD/INSTL PV(SOLRELCTRC) SYS ON RESDNTL ROOF
in full farce and effect-
3
License CI}ss Lie.,
q Dam /../ �—Conlrurrr
n t-7W —�T�'T�AYtCHf1 C S DECLAR ON
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I understand nd my plansshag be Coed as public rtcmds
Dipu
gLicensed Pmfcuianal -
3 OWNER-BUILDER DECLARATION
i2 1 Wmby aRnn Nn I am exempt from the Contractor's License Law for the
i O Oa, following mason.(Secdan 103 1.5,Basin.add Profwiou Code:Any city er county
which inquires a permit to Construct,alter,borrow,d.--]M.or repair any strunum
Si< prior to its iuuamC.also requires the applicant for such permit to file a signed summent
that he is licensed pursuant to that,provisions of the Conmecterl Limns,Law(Chapter 9 Sq.Ft. Floor AreaC Valuation
E~$ (commencing with Section 70011)a Division 3 of the Business 4
sand Professions Coll) 44056
r3— that he k exempt Nerefmm and the Luis for the alleged exemption.Any viola0on of
Schon 7031.5 by any applicants for a permit subjects the applicant to a civil penalty ofNumber Occupancy
Cot more than Bw<hundred dollara(s )k 36653020 .E I)ane Y Type
i,u ownv oldie property,a my msplayca with wages u Ne'vsok rompenutian,
will do the wall,and Rationalism a aol intended or afkrtA for race(Sac.7014,Bu mems
and Profesumus Cade The Cmatrsckmes Li.Law does rot apply in an..at of Required Inspections
propmty who bu ilda or improwa thermostats!who does such wart himself or through his
two emPlaywt awarded that such improsemenu artnot intend oroRued fords B,
hmwewr.the Wilding or improwment lasoid within ane yearof completion.discounter.
Wilda will Noe the burden of proving has he did all Will W improv far pumem of
sat.).
Q 1,as mvner of the property,am a clusiwly contracting with licensed contractor in
emrsuuct Ne project(See 7044.Business and Pmfestieu Code)The Caasacur's Li- .
ewe Law does mot apply to an owner of progeny be Wilds or improves therms,and
who coneracs for such projects with a mnCactar(s)licensed pursuant to the Contractor's
I.iceme Law.
❑1 am exempt under Sec .B R P C for this;mason
u
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of toe following declartiau:
❑IMwand will maintain aCenifiase of Consentuself-imuinforWar4r'sCompcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
welt for which this permit is istra l .
❑I bare and will maintain Warkefs Compensation In.uanm,u Icqumed by Section
3700 of the latter Call,far the performmm of Ne wort farwhich this Formula;iuoe4 '
My War Campensadan_I=,CCC2 crand Policynntun rr wle�.��Q���{�
Cartier. �n� Polity No.:S�(/��IIV ws
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nk section red ret he conpkmd lithe permit is foram hundred dollars(SIM)
or ins)
I crsdfy then in the,perfamrame of the wart for which this permit is hired,I shall two
...ploy any perm.in any manner so u to become subject b tie Workers'Compensation
Laws of CaNfamia Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you shonld
become subject to tW Clericals Compcudtion previsions of the tabor Code,you mass
.,,z renhwith comply with such praviriou or this permit small be dmmd nowked.
.zt O
7) CONSTRUCTION LENDING AGENCY
[-� k for which IN this Vert iso Consuec.30 lending .) for the perfurmamm of
0.! .�. the war's for which thds permit k issues(Sec.3097.Civ.C.)
t[1 Q ladcr's Name
.7. z Undoes Address
U C) 1 clarify that 1 haw mad Nis application and sou that the all information is
IL f' Carmel I stns,b comply with all city and county ordinances and sure laws inlating as
0 V Wilding construction.and hereby aoNorim mpmsenutiws of this city to enter upon Ne
abme-mentioned property for inspection purposes
(we)agree to saw,indemnify and Inst,harmless the City of Cupertino again,
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liabilities,Judgments.costs sadeapcvu which may in any way accrue against said City
t.)',z A APPLICANT
of thepanting of Nu permit. �7
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date LI,
SO REGULATIONS.
�Al /liyv�- Zd 61zyAff Re-roofs
HAZARDOUS
j'
sG§nu�i rc arApplraDam,
Type of Roof
NAZAADOUDOUS MATERIALS DISCLOSURE
Will Ile a Cuan no forum Wading attupantswm wand t e Health and
u dinner!
el by the Cupertino Municipal Coll,Chapter 9.13,and the Health and Sa(cty
ode.
Seldom zss3xa)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs �Nm
If a roof is installed without first obtaining an inspection,I
Will ft applicant or future Wilding occupant tax equipment w devices which g agree to remove P
mailhavardou all concomitant u de0md by the Bay Area Air Quality Management all new materials for inspection.
❑Yea IQNo
I haw mal the hmNeus materials requirements under Chapter 6.95 ofthe Califer-
-is Head"SarmyCde,Sec6ats 25305.25533 ad 25534.1 understand than if the Wilding
data Cot currently haw B Imam that it is my mapeuibilily b notify the occupant of use
mq.mmcmawAkh."be .rmlke..racanifcamof0.cu Signature of Applicant Date
LOwne,oranrberamdaCma Dam All roof coverings to be Class'A:t'or better
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