06080219 (2) CITY OF CUPERTINO ti -F-a' » *� '� +
BUILDING DIVISION PERMIT CONfRAGTOR INFORMATION
CATV Y•4gd�w;
BUILDING ADDRESS: AKEENA SOLAR PERMIT N0.06080219
22354 CARTA BLANCA
OWNER'S NAME: PERMIT LSUEDATS
HELEN YOUNG-LU 605 UNIVERSITY AVE08/28/2006
WF SANITARY NO. CONTROL NO.
(408) 867-0558
ARCH1ECDENGINEER: BUILDING PERMIT INFO
BLDGIO EO LECT PLUMBO MECH O
LICENSED CONTRACTOR'S DECLARATION Job Description
I hucby allirm that I am I'Im tied under Provisions of Chapter 9(commuelnZ p
with Sudan 7")of DivWon 3 of the Budners and Professmant Code.and my Items,is
inrallforoe,nO Off - INSTALLATION OF 35 ROOF MOUNTED SOLAR MODULES
? Llccnse Clw Lie.N
Dam Contractor
1g- RCHITECTS DECLARA ION
N I understand my plans shell be used as public records
16u l
,p
Licensed Professional
y OWNER-BUILDER DECLARATION e�
<5 I patchyto affirm on I am sump+from tW Cantrwors License law far tie
OO whichfollowingmreasIpen. mitI 7allo03 LS,Eua fteuandove.amuu Code:Any city or county (o
:20! which rcquime a permit ...ntrwt,aper.Improve.su demabit u as repair any urement 35550
iZ pdartoiuiensedp pursuant
the thovisio so far each pcmi's Ukar eLaw shapter t
s � (comma lkensedpursumttothe ofDivimuofthe Corotom ndPropLaw(,Code)9 Sq.Ft.Floor Area Valuation
B
(commencing with Smtfor70ndth badson3af the Buinwonder.My
Code)or
that he u exempt therefrom roti the buns for the alleged,...,nptian.My Halation of
Seeban 703M by any applicant for a pelmft subjects the applkul to a civil penalty of Occupancy Type
not orae than ftw hundred dollars(Z300).
1,uawrvaofWpmMq,mmywploycawithv gesuftirnlecompeneadon,
will damewark.amal the stmmorekmatumeedorofferedro mla(See.7044.Buineu Required Inspections
Nd PmfCVlam Cade:The CmlbammS LICCNC Law dm INm r�
q C
dam apply an Owner of
property who builds or Im proses thereon,and who does such want himsel f m tiuough his
awn employees,provided Ihatauch impmwments arc not Intended tiro@red forsde.ll,
however.the Wilding or Improvement is sold within am year of completion.the owner.
builder will luso the burden of graving that M did not build m improve for purpose of
uk.).
Q 1,as aw'aef of the Property.w exclusively commeting with BCenYd cotmaetoR to
construct the project(Sec.7044.Business and Pmfesslam Cade:)The Cmvutors Li-
ceme law does not apply to an owner of Property who With;or improv theater.and,
who cantrcer for such pmjec s with acantrsctor(q licensed pusuant to the Contractors
Lice.Law.
0 lamesemptunder See. ,fidPC for thio matin
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby drum order penalty of perjury arc of the following declwtions
ham and will maintain a Certificate of Covent to self-usemfar Wark sCompen-
ntton.u provided for by Section 37M of the Inbar Code.for the performance of the
work for which this permit is Issued.
❑1 haw and will maintain Workers Compensation Insurance,as required by Section
3700 of the labor Cade,far the performance of W wart far which this permit It Issued.
My Warkers�Cargpea�on�nsuruRs PRICr Nd Policy a Wabef aR:
Can of - W�i II m //af s Panay Na_465—�/NP
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE -
(This motion used net becomplocd Ktie Permit Is foranc hundred dollars($100)
or Ica)
I certify that in the pufonnmee of the work per which Nis Permit is issued.I shall not
employ any Person in any mannerso u to became subject to the Warken'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cornficae of Exemption,you should
become subject 0 the Worka's Compensation previsions of the Labor Code,you mum
.J O forthwith comply with such provisions or this permit shall W deemed revoked,
^" CONSTRUCTION LENDING AGENCY
Thereby alRrm this Overseas construction heading agency for the Performance of
CY. use work fm which this Permit u normal(Sec.3197,Civ,C.)
Ig3 Q lenders Name ,
] z Landers Addmo
U Q 1 certify that I have mad this application and sure this rho show information is
D.P correct.l agree to comply with all city and county ordinances and state laws m1mag to
0U building construction.and hereby authorise¢prescnutiws ofthis city to anter upon the
0. ahow-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmlw the City of Cupertino against
ti Iisbilides,judgnunu,coses and exp eyes which may In any way macrm agafnsisted City
U in consequence of the Zooming of this pamlt. 7 f�
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
* W— Re-roofs
Sigmturc ofApplicu DataHAZARDORDO US MATERIALS DISCLOSURE Type of Roof
WIII the applicant mfuture Wildinge.Chaptstorcaandte Health
eadoosmamdal
u alcOmd by tie Cupertino Municipal Code.Chapter 9.12.end sere HW N and Safety
Code.Section 25532(a)7 ��ff'' All roofs shall be inspected prior to any roofing material being installed.
[Dy. �a
�- Wlll Iho applicant or future building occupant use equipment or devices which If a roof
1S installed without first obtaining an inspection,I agree to remove
t hmardous air Contaminates u deflated by tW Bay Arca Air Qadlly Management all new materials for inspection.
Disvicl7
❑Yes �Na
I have mad the haaamws msaadau requirements under Chapter 6.95 of de Cali for.
ria Heal"Safety Cok.Semiam25305.25533 ane 25534.I undersand Rndom Wiping
dam am cnoeatiy haw a entre thst II'a my responsibility to nobly the occupant of the
requirements w2. hheh muss be met our to ismanm ofa Cerdfeae of wary. Signature of Applicant Date
.- �iz;za - �2Lad All roof coverings to be Class "B" or better
Owncror mthamcd agent- Dam