08070198 CITY OF CUPERTINO �* s�• , .t"-' �•"_
BUILDING DIVISION PERNIIT �'.CONT UBTJQRJNFO�MA 0N,
BUILDING ADDRESS: PERMfr NO.
1,145 YORKSHIRE DR REGRID POWER 08070198
NIRS NAME: PERMR'ISSUE DATE
_ EN AU 1624 DELL AVE 08/06/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
'BLDG ELELT PLUMB MECH
3 G p LICENSED CONTRACTOR'S DECLARATION O O O O
1 hereby affirm shu T am licensed under pmvisiaos of Chapter 9(commencing Job Description
nz16
with Secdon]mu)oi'Diviuon 3 of we Business and Puresdoru Code.and my lleomeb INSTL PV(SOLA ELCTRIC) SYS ON RES ROOF
n„ mrullre"amul alf¢v /U 36 �p-r�9�.573o
nJZ Date
t -OU!6-.
C Cmtrgamor Ad - ohatr-
.
G ARcllrni S DECLARATIeN d
I understand my plana shall he used u public mcordf
fleu
g u. Luensed Pmfessianai
50 OWNER-BUILDER DECLARATION
1 Wreby affirm that I am uempt from the Contractors License Law far Ne
Coo following name.(sestion]031.5.Business and Pmfeasions Code:Roy city or County
Coo
f! which requires a Permit to convncl,alae borrow,dcmmlLN,or repair my-acture
prim a its issuance.sum;requires Ne applicant for such permit a file a signed wmment
< Mad WI.licensed Inumant W the rrovislmu of the Conamar's Umnse Iaw(cMpter 9 Sq.Ft. Floor Area Valuation
$ (car"o.mngwiNsection 7000)ofDivision 3ofthe,Business and Professions Catu)ser $18600
Nat he Ito exem se
upl dumbea the bub fm the alleged exemptio,Any violW6n of
Seinen 7031.5 by airy applium for a permit mOjecu du applicant to•civil penalty of �p7�Number Occupancy
am more than live hwWmd dellau(1500), 36207021 .7TU" T'Pe
0 1.u owner of th Property.or my ereployces NN wages u Ne'vmu compuuado.
and Prshewart,and Ne she unbotuuMedm Law
Out a(Sec.70 an,Busia•v
and enywilens Cade:The CanuactoA LIC-16a Law dean oat apply lf an om,tc of Required InSpeCUODS
pupectywW Wilda provided
ansuch improvements
who daesamhwork hiroffear Waugh his
ow weeny rWildinHdd W overacmprovedwits ase net intended oroRemd forsale.Me"n t.
however.Nc bueMat arimpmmnantg Mat within Cure Wild of mmove for Me"net.
of
Wieder w10 have 0u burden of proving Nat W did not bulid or Improve(m purpose of
ale.).
0 1.as awne of the property.am Inclusively cmuamicg with licensed commus rs on
mmeme t the project(See]Gad,Budnm sod Promadoos Cade:)The Covaclora U-
ante law d.ret a,dy to an owner of property wW bull"or my.Nermn,and,
who mmaca for such prejums NN a contractor0)licensed puwvt a IW Contractors
License Law.
❑I am camp,under See ,B&PC for this14
er Dale
WORKERS COMPENSATION DECLARATION
1 hereby a ander pcnaily at perjury ars of Ne rolawing hclu hi:
sa Iha.eandw01maintain•cef aael farWorkersCompen-
utio, fpe by Smtion37W.f ftLabWCo .f. a prfomncof N
wort for which this
permit is issued.
0 1 have and will maintain Woron's ComperuNon Wumco,u required by Sectio
3700 of the labor Cade,for Ne perfarrnmm of W vert for which this permit Is booed '
My Women's Compeosatio hsrrma urian and Policy number are:
Canier::4099 1ES71 C _PoBcyNo.:Can D7039fh-Ol
CFRnFlGTE OF E%EMMON FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need not bu compleud If tits permit is two=hundred dollars($100)
or seas,)
I Codify Nat In Ne performance or W work for which this permit is homed.I snail not
employ anypemn in my mummer an d to become subject to W Women'Compewdom
Laws or Csiromiu Dau
Applicant
NOTICE TO APPUCANI:If,afar mW ng this CeNfiuto of Exemption,you Nada
becemt subject a Ne Workers CamPemNo Pmv13 yr of W tabor Cod,You mud
�0 forthwith comply wish such provisto e;m Nu Nunn Nail W doemed revoked. .
„z„ CONSrRUCnON LENDING AGENCY
l.. I hereby affirm that them is a commucti m lending agency for Mc perfurmanco of
C> she work for whim Nb permit b issued(Sec 3097.Cb.C.) .
W Q Lcodces Name
=z Lenders Address
U O 1 unify Nat I lave and Ws application and sum than the above infonmon is
LL Correa,I agree to comply with all city and county andMa noes and suss laws reining to
.Q Wlldagconstruction,and hembywshodse repreunutiwof this city to emurupnnf
W above-memianed remperly fur Inspection purposes.
(We)agree to um.indemnify and keep harmlw she City of CupCIMM against
t97 liabilidu,judgmmu,costs and apenses which may In my way acaue Malml said City
U_Z eorueq W of she gmWg of Nb permit
A
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUII..5II99NNS.
IL4' r Re-roofs
Sigauure of App iam/Con I� Da e
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will W appBunt ar ruam building amupanl atme or handle hmutlmo material
as d0ncd by W Cupertino Municipal Cod.Chapter 9.13.and W Health and Safety
session BMW? All roofs shall be inspected prior to any roofing material being installed.
Dyes IffNO
Will Ne.'Ikant or future Wilding oceupant sec equipment Or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit huarlous air cotamimm as defined by Nn Bay Area All Quality Management all new materials for inspection.
DimiC17
0Yes 1Nu
I have readthehavanfmumdmiab reguimmenu underCWpur6.95 ofshe Califm-
Health&SafctyCode.Scinto MSW.25533am12533<.luMrmwd ifW dtildng
n not come"Ify haw a—4 Nu it b my mapomiMlily a mufy W neeM ant or da
Z
requlmmcn ;;Wuet phrior tour.oda Certificate of Ocmpancy. Signature of Applicant Date
Owner m auNamtd agent
onto All roof coverings to be Class'W'or better