08040222 CITY OF CUPERTINO
BUILDING DIVISION PE �OAI,?CRACT(R I�,`WR,MATJO
BUILDING ADORES': PERMIT NO.
].0333 N WOLFE RD STE 89 ABSOLUTE POWER SYSTEMS 08040222
NER'S NAME: PERMIT ISSUE DATE
MACY ' S WEST C/O BILL PO BOX 800985 05/20/2008
PHONE h r n Ty
T r o SANITARY NO. CONTROL NO.
(661) 775-4893
ARCHTIECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O p LICENSEDCONTRACTOR'S DECLARATION Job Description
thereby hby affirms this am 1 li¢mW under Provisions of ChaPw+9(Commencing P
wilbscon 7MmOlDivision 3 ofthe Entireness yd Profeuimuf,Qde� myliccnaeu INSTL ROOF TOP SOLR ELECTRICL
in full force and effect GiF
j�� fine 1 L'c.a .
n qq Dete Entrsemr ..
W ARCHITECTS DECLARATION
` 77 1 uMvvand my plans mail be used as,public records
ClcU
k LLO Licensed professional
5 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Conm choes License Law for the
p o following reams.(Section 7(31.5,Busings and Pmfevion,Code:Any city or c.u.ry
S_ whrcht requires a pormir .cohmnn,alter,improve,demulLslL Or repair any su.cture
prior m its ismance.atm squims lM applicant for such permit to file a signed staasment
ss< thm he is licensed moment s the pmviaimts Of the COnmmmrs License Law(Chap=9 Sq.Ft. Floor Area Valuation
yF$ (e.mmeneing with Section 7000)of Division 3 of the Become and Professions Cade)or ].050(]0
Q Nat he is camera therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil PmAIty.r umber Occupancy Type
ret tome than fiva Wrolod dalars(3300) 31620089 . P y yP
1,u owrcs of the pmpmy.a my employees with wages as Iheb mk eampehtsaton,
will do the work.and Use suectnre is ret intended or offered for sale(Sec.7044.Busw•.
and Professions Code:The Cor mems License Law don hast apply as an owoer of Required Inspections
property who builds m improm thveon,and who does such work himeaf or through his
Own amplayen,pro ided that such improvements art mtimeodea v.Rmed for sale,ff,
however.Ne building or improvemant is mid within ane Scar of complauon,on,awnv-
builder ,will have the burden of proving that he did ret Wild or improve fm purpose of
YIC.).
❑1.u owner of the progeny,am exclusively cmmcti.,with licensed Contnctum s
Construct the project(Sec.7044,Business and Profccal Cade:)The Contractor's U. ..
cense raw does not apply m an ovmer of property wW builds or improm therm..and.
who concocts for such pmjem with a c.ntrmmr(s)licensed pursuant to the Conmcr.rs
r3cemm law.
0 lamexemptundn'ee .Bh PCfmhhismamn
nes Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury orc of tee following decWvlons:
sat1hart and willforbyneCertificate of Code.
for Worth C.mpem
work(r provided(Pe mi Section 3700 of rte labor Cade.for the pesfarmance of the
work for which this Permit is iasod. t
0 I have and will maintain Workers Compensation hammed,as;required by Section
37W of the labs Cade,for the performance of the work forwhich this permit is issued. .-
MyWorker �ogLpemsam.huunnacar�rier and policy.�..se{xvr�amga�
C--rier. " ansae f`SA�Iicy No.:�_
CEMMEUE OF EXEMPTION FROM WOORRR�ERS'
COMPENSATION INSURANCE
(ThisacNw oecd arrive eonpleted if the Permit isforeoe hunNed da0us(SIM)
or kis)
I ceni( that in the performance of We wok for which this Permit W issued,l(hail not
employ anypermn in my mamrerm at to become subject to the Worlmn'Compensation
Laws of California.Date
APplicmi
NOTICE TO APPLICANT:If. for making this Certificate of Exemption,you sh mW
Income subject to the Workces Compensation provisions of the Labor Codc,you mud
.J z forthwith comply with such provisions or Nis permit Nall W doomed revoked.
z"a CONSTRUCTION LENDING AGENCY
[-ice I hereby affirm that then is a construction lending• for the mma�of
.) P
the work fm which Ihu gamic u iuoed(Sec.1091,Cir.C.)
Q Lenders Name
z lenders Address
U Q 14vtify than I have mad this application and sure thn the above information is
D.- ..CL I qse he comply with all city and county mdinuwn and state lawn relating m
-C) Wilding Communed..,and auth
hereby orise rtpreavhtaum of this eitY m cater upon the
W shove- d pmpcny fn insPecuan pmpnma
c)ag to 9ve,indemnity and keep harmless the City of Cupertino against
r�jj s.
liabil' q,jneg m`coats esles hint may in any nY mneme againtgidCry
inn sequence ranting is pe it Issued b
AP ICA D A S
LS a¢ ^/
HAZARDOUS MATERIADISCLOSURE Type of Roof l`
Will the mldicant m forum Wilding aqupanl uort mlundle hauNow material
aUned by the Cupno Municipal Codc.Chapter 9oma t.13, e Hm th and Safely
.semi..zsslz(,)7erti
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding.ccupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxarm. it centsmmarts u defhncd by the Bay Area Al,Quality Management all new materials for inspection.
DcanctT P
❑Yes
ave head rte hn�hdrmmyeErr��aa nomhm
ccrosunderCMthe
pter6.95ofCalif.r-
on. I Safety Code,Sttsi0 QSMi5533and2553d.lunMrsundthuirNe Wilding
rete t or a Icon a my responsibility as the occupant of the
req .
�G�(//DowA All roof coverings to be Class'W or better