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04050026 (2) CITY OF CUPERTINO *�'••• xs e;t' �'" v- , sax.- "' ^,�'+ RIJILDI14C DIVISION PER ] CONTRACTOR 4NFORMATION " BUILDING ADDRESS: PERMIT N004050026 4050026 41 NCR NAME: PERI,117MUEDATE ROD LIVINGOOD4'12 PHONE: SANITARY NO. CONTROL NO. ARCHITECGENGINEER: BUILDING PERMIT INFO BLDG ELECrPLUMB MECH 0 0 0 0 'tiro LICENSED CONTRACTOR'S DECLARATION w❑ 1 hereby affirm that I..licensed under provisions of Chapter 9(commencing Job Description iW withsc 7 MBaf Divisian3ofthc Businexs q,dp'aI inns CoM,atl liccmcis -^fin in full fir Jc(fcn. J� �}v "3 Lien Baso C /b Les �2 7nb SOLAR ELECTRIC SYSTEM wDacntrara "a CONTRACTOR: SUNSTAR . ENERGY, INC ARCHITECTS DEC RATION ¢i I understand my plans shall he used as puhlie rtenrdx >aU 3 LLp G Licensed Professional i 3 OWNER-BUILDER DECLARATION I toothy mErm Nat 1 am exempt rtom the Contractor'.License Law for the p o following mason.(Section 7031.5,Business and Professions Code:Any city nr county X 9 fi which mqulru a permit to construct.alter,imprnve,demolish,or repair any structure u—'^ prions its issuance.also requires the applicant foramen prmitto rile a,signed statement Nat he is licensed pursuant to the pmvisnns of the Contractor's License law Charter 9 Sq.Ft. Floor Area Val u$t*p000 (commmming with Section 70M)of Division 3 or the Business and Professions C.im)m Na(he is exempt henchmen and Ne basis for Ne e1lcgcd exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mare Nan five hundred dollars(35M). 36917030 . 00 p y YP I,as owner of the poi or my employees with wages u their mole Compensation, .Al dathework.and he Contisnot intended mawit for sale(Sec.nod,Business and property wh bis Code:The Contractors .d he Law lou or apply lf an owner of Ilgi81t714UI;Wy Ifl C property who builds vi ed Mai sucentro,and who am not wad himudf arNmugh his hSO owever.dreu,ping or i proveh improvementsamne intended forem,oaide.r. - ,/ q q hwemr.illbantling as improvement is sold edidnone year of completion,Ne owner. MAY 2 O LOO4 builder will nam Nc burden of proving Na he did not build or improve for purpose of talc.). ❑1,as owner of the property,am uclusivcly contracting with licensed contractors m ����®��� construct Ne project(Sec.7W.Business and Profusions Code:)The Contractors Li- p ccnstLaw duo not apply to an owner of property who builds or improve Nencon,and. ��D RTS � who contracts for such projects with aconlncmpursuant rts)licensed pursuano the Contractor's rp License Law. I am exempt under Sec ,B h P C for his mason Data WORKER'S COMPENSATION DECLARATION I hereby affirms under penalty of perjury ane 0170¢following declarations: ❑I ham and will maintain a Ceruacam oreonsent to sclr-insure for Workch Compton- . titian,as provided for by Section 3700 of the tenor Cmc,far the pcommtance of he . work for which this permit is issued. ❑1 have and will maintain Workcri Compensation Insuran<c,u required by Section 37W of Ne Labor Code,for be performorm c of the work far which this pumit is issued. Cy Workcfs Ct�[;eamon lnsma.WriPalin!f7V1 ?15 . S CERTIFICATE OF EXEMM FROM WORKERS' COMPENSATION INSURANCE (Thu section need nut he completed if Ito permit is loran:hundred dollars(SIM) or Is..) 1 certify that in me performvsc or Ne work for which this permit is issued,l shall nut employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this C:N CmC of Exemption,you should became subject to Ne Worker's Compensation provisions of the Labor Code,you mum .JO raMwith comply with such provisions or this permit Nall he Claimed revoked. Z o CONSTRUCTION LENDING AGENCY P4 I hereby affirm Nat Nem is a construction lending peray for the performance of O: 7 the work fur which his penin is issued(Sec.3097,Ci¢C.) W Qa,Lenders Name G lenders AEdrusand U O 1 comfy Na 1 Inns sad this application sen sure Of 13 above information ie (J _ W F^ correct.1 agree to comply with all city and county ordinances and sate laws mlaung m - CJ(_) above -mentioned hcmbyamharnerposes.representatives of Nis City toenter upon Nc ahOvc(We) ed properly for im indemnify an purposes. (We)eg judgments,to cast,indemnify and hich harmless w City tar Cupcnits against U7 Iiaconseqencofthecosts and of this expenses which may inany wayaccmc against said City UZ Aconsequence of thegmntingof this permit. ^ APPLICANT ERSTANDS AND yyVVJJpp,,..L COytM PLY WITH ALL NON /-POINT Issued by: Date SOURCE ATI j.�!/i'�wL-��� ///O�. \ / y/ EpidtfurcofAppiicantiCon amor Detc Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant static or handle hazardous material defined by Bre Cupenina Municipal Code.Chapter 9.12.and the Health and Safety Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu f9'Nu Will Me applicant Or home building ocampantMat equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by but Bay Area Air Quality Management all new materials for inspection. District? ❑Yes k(N0 I have read Ne hunrdous materials requisomm,;under Chapter 6.95 of the Califor- nia HcnIN A SafetyCale.Sections 255(15,25533 and 25534.1 understand Nu if the Wilding does nor cunte enlly haw a nan that it u Ummitirionfintra.nnuly the maeuPam or Ne mgmiremCO. mIf/WS Iprior Or atte .cNBeate OCCUPann. Signature of Applicant Date 4g_n - -'ca n D"e�y� All roof coverings to be Class "B" or better awn CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM U `���v �CUPEkTINO APN # 3 / ( Date: Building Address: gb 5- C'e� d D Mailing Address (if different from building address): a t woe r �1 Li Fr1,-1 v C Owner's Name: em L;LPhone #: � , y -06�� / Contractor: /1 TK�� Tle License #:C/ $ 1 z 7 Y4� Contact: 1 Phone: yD5 O38-SycO Cupertino Business License#: �lL1i<ir liwl Fax: OX 395-IV)-( Building Permit Info: Bld Elect Plumb ❑ Mech ❑ Job Description: Residential sUz Commercial ❑ Sq.Ft. Floor Area: A $/Sq.Ft.: Cost of Project: �j9/ L066 Occupancy Group Type of Constructionsvrc14 �r�G 5' S f Please check this ( project is a Y t second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BB0ILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA�(�/ Investigation fee BUILDING c7 l of 3 V7. 3� ��� SRI CITY OF CUPERTIA CITY OF PERMIT APPLICATION FORM CUPEkTINO db Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING 1 BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstallIAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIl2HAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREND,q PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL 2of3 E� CRY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ' CUPERTINO Quantity Fee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL \ BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Change BUILDING 3of3 It Gt vo(n?l aN1Id El"C C2— E iti x_ 44 r a CRTC gw- (Q;(j)JR-PWIO '"'Co < , 2 £ri QG a J R��'i� BUIL o �� r�E�tc,�Nn�Q�4T 'm�Qgfm �6Sef;" r r m i - ,.,,\r-+.-,.11l�:)n,�� 7 �r�i�� 'uiP�7_Oato CrU A Ila G4� N CS A, _1 IN ACCORDANCE WITH THE Crffl&` CUPERT 0 _ 11 L OATE.. M F S ; set of pians and sp.clfications MUST. 0- " I' �* on the job at '.1 times and it is uel K £ N C �' A ^tly=i t .t�. De kept lawful to make any,C angel or siterations p d3 ' nn game without wdtion permission from- 4 u�N. =; _` cupmano. J \I ti :rr In0 punun d 0 Tho oln(npin1 of this plan and specifications' s $HALL fJOT be hold to p rmit or to ho ar, m ,pproval of the violation It nny provrSron= F r nnv City Ordinance or ')t& Law. F D J 0 F s F iJ v2� 1 �rr� � _ tl. MAY 04 004 CII ®F C: PERTIN® B�EB.D!N DEPA??TMENT 7} o§ j \ � : �G^ 0 ® _, �§ � o§ �k E % I : \ 77 &/ . -4 \ { _ � �/ !a] w ir/ m m ,®� a2 § J $ / 7� )� - k %) (} ) 2 t§ a > k/ §% S �§ k� -1 u } ( k \ ( � § § | z ° } z R � / § Ids § ta 2 z4 »2§ $ } §§2 ° m ! »mE§ . ^ 1�- B ) k \( (k |2 1-- o --me cc - !k �§ , CL - - -4 \ / } MW\\ §) 2k . k k $LL ( /0,O - §k &) § \2 B� ° , i{ cc Z � � £ (�( (\ )j 2 R @ § :§, waa§ § 2 % 2 « 2 �®- ¢¢ b2 % # ; k % U \� §) [ Ir § z ) / / Po ES / k �O\ § \ ��0 \� ®2 § ) } 0 � | {j « & \ per § c§ a P � � � � • - -------� it aB , §� ■ kms§ 4 0 � E2 co $ - O § 2 . ■ 40 . Ott � a � MCo � ! I § © a a � § Um) � % a k - ■ - $$ k I ch ( - " | . 2k � a $ |� 7J ! ) 2 §� �| 6 : f kfa 41 ! k§! � S eu % � GO � � � - � § � � ■ / / ƒ &A %0 j Flartriral and IVlorhaniral r:harar_tarictir_c HIP-J54BA2 Electrical data Dependence on irradiance Maximum power(Pmax) [W] 180 Max. power voltage (Vpm) [V] 54.0 Max. power current(Ipm) [A] 3.33 Open circuit voltage (Voc) [V] 66.4 4.50 (Reference) CN temperature:25-C Short circuit current (Isc) [A] 3.65 400 """' '°"00W""" t0 /m' Warranted minimum (Pmin) [W] 162.0 3.50 . - - - - rMaximum system voltage_ [V] 600 3.00 ........-..e) w< .__..; _.......... ................. Series Fuse [A] 15 2.50 .............:..............;......... .. ; ............. SooW ar PTC rating 168.1 _ U m' Notel :Standard Test Conditions:Air mass LS, Irradiance=t000W/nl', 150 400W/ ....... . ............. Cell temperature=25`C Note2:The values in the above table are nominal 1.00 -.. Zfxtwim;.......... ....... - . .......... Note3:PTC stands for-PVUSA Test Conditions.'PTC watt rating is basetl on 0.50 .............:.............:.......... ... . .......... 1000W/m'solar irradiance, degree Celsius temperature,antl tm/s wind speed.The PTC wan rating is lower than the*Standard Test Conditions- 0.00 (STC),a watt-rating used by manufacturers. 0 20 40 60_ ^ 80 Dimensions change voltaSle II unit:mm(inches) 11 ^`1 m th{�F3n 35(1.38) 16(06]1 Bruunuin,(1 Place) 1111111 1, ,, . M J35.26) 07 e.zz ao 7W Dependence on temperature - Jurletbn Box loEal 4.50 (Reference) nevalhe� d Pnsinve + I AM-1.5.10o0W/nt' IV/ 4.00 ISI —� — A connect(Mc Plug) 3.50 -I - i i 3.00 A A Q 2.50 - �- 75°C - m 50°C � 2.00 f 1.50WC Front Side Backside 1.00 �---� - T-- 0-C 0.50 ( - I o 00 `u�ml Weight:15kg/331bs 0 20 60 80 Vona9 M Voltage 7 Section A-A Warrantv Certificates Power output:20 years UL Listed Product workmanshin: 1 veer CEG Listed Q CAUTION ! Please read the operating instructions carefully before using the products. Due to our policy of continual improvement the products covered by this brochure maybe changed without notice. • nlstrih,,IM by Please consult your coca[dealer for more information. -T EC H N O LOG 1 ES 1.155 Flathush Road.Kinoston.NY 12401 To I:845-336-0146 Fav:.P_,1_5-333__M S7 UnLNY an ur ' coxa SUNNY BOY WVERIFR GROUND NEUTRAL a a - w• of - u AC DC DIS^.ANNECT w- DISLONNEU SW RCN SWITCH w ARRAY K DlsTmeunDN Specifications PANEL EARTH GROUND Inverter Technology Real sine-vw.e,current source,high Frequency PNM AC Input Val" 211-2641240 V AQ or 183-2291208 V AQ S9- flb�e grew?(�SMNs - aAC Input Frequency 59.3-60-60.616D Hal,50 Fh also manufac- DC Input Voltage 250.600 V DCluring philosophy that combines simple Peak Power Tmddng%huge 234-550 V DC la 240 V ACI ADgnwith robust execution. SMAS slate-of- Minimum DC Input Voltage 207-256 V dependent an available line vol" the-art maximum power point tracking performance results in Maximum AC Pb 2500 W 1240 V AQ 2200 W IMB V AQ greater real-world energy capture than any other grid-tied PV Current THD Ins than 4% inverter. Sunny Boy's safety and reliability record is also exception- Powe Factor Unity,Peak Inverter Hfirimy 93%-94.4% al due, in part to the imams redundant grid monitoring and Cooling Commit=cooling Ino Fm) built-in ground fault detection and interruption protection. The PV start Voltage 30DVdc inverter's IGBT power sage generates a nearly perfect sine wave Maximum AC Current 10.4 A with the lowest hormonic distortion in the industry and meets new Maximum DC current 13A ultro-skid FCC EMC standards. SMXs unique Sang Inverter tech- DC Voltage Ripple less than 5% nology makes future system expansion simple. Sunny Boys option- Pmw Consumption D W nighttime,<0.25 W stomby al power lime corner communication capability allows for extensive Ambient Temperature -25*C...+60°C dato acquisition from one or many inverters with no additional Endnure NEMA 4X slo nless strJ wiring. (Optional powerlme modem required.)Other communico- Size 434 W x 295 H x 214 D mm tion options are available to satisfy almost any application. Weight 32 kg Certifications Untied States: UL 1741,E210376,UL 1998,IEEE 519,IEEE 929 ANSI C62.41 Cl &C3, FCC part 15 A&B International: DIN EN50082 Part 1,61000-32,50081,50014,600055 Part 2, 55011 Group 1 Class B,50178,60146 Part 1-1 SMA America,Inc.,20830 Red Dog Road,Grass Valley,CA 95945 Phone 530-273-4895- Fax 530-274-7271 DISTRBUf®BY www.SMA-AMERICA-com•amail:inFo@SMA-AMERIG4.com • SMA Regelsyseeme GmbH-Hannoversdne St arse 1-5,D-34266 Niestetal Tel. 1+49)5 61 95 22-0-Fax(+49)5 60 95 22- 100 www.SMA.de-email:into@SMA.de s I Advanced System Technology for the Successful Photovoltaic Future CITY OF CUPERTINO %- BUILDING DIVISION PERMIT CONTRACTOR INFORMATION see_...-•.• .< ...<a. _.�. m., .v ,.!.,� tet_„, af., BUILDING ADDRESS: PERM""0q050026 T"0 4,0 5 0 0 2 6 ERs NAME: PERMIT ISSUE DATE ROD LIVINGOOD ONE: SANITARY NO. CONTROL NO. ARCHITEC ifENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LOp LICENSED CONTRACTOR'S DECLARATION O O O y V C 1 Mrtby affum that I am licensed under provisions of Chapter 9(commencing Job Description haw with on] )ofDivision3oftheBusimut d})raGsslumCode,a d'ryrlicc ecis 0 , mmnm ndercttaL �C '�” j27nb SOLAR ELECTRIC SYSTEM p Z'ta Liccme� ass z—c Data n �/ con,cm / -'a CONTRACTOR: SUNSTAR . ENERGY, INC YY~ CI-S DEC ATION y¢t I undershoot my plans shall W used ex puhlicrt=W, y G_ MAY 20 2004 �yV tar r Licensed Professional OWNER-BUILDER DECLARATION BUILDING ww sb u 'W a i E I kmhy affirm Nm 1 am exempt from the Contractors License Law for the r�"UIA �II�f� 00 following mason.(Section 703 1.5,Business and Profeasiom Cadc:Any city of county x m which requires a permit to construct.alter,improve.demolish,or repair any swcture m—'^ prior to is iartoon .also requires the applicant for such Permit o Ale a signed statement that he is licensed pursuant to the provisions of the Comractor's Licanse Law(Chapter 9 Sq.Ft, Floor Area Valu$gppo00 E,Fa (commencing with Section 70M)(if Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not ream man five hundred dollars(SSW). 36917030 . 00 P y yp ❑I.as owner of the pmperty,or my employees with wages as their sole compensation. will do One wars.end dte swnum isnot intended oronemil to,set.(Sec.71314,Business and Professions Code:The Coroacmr's License Law does not apply in an owner of Required Inspections property who builds or improves mcmon,and whodoesauchwurk himself orthrough his awn employee,provided that such improvements arc not intended cropland!forsale.If, however,the building or improvement is sold within ane yeti of eomplction.the mvner. builder will low dte burden of proving that Im did not Wild or improve for purpose of sale.). ' O h as owner of tW property,am exclusively connecting with llcau dl contractors to construct me pmjen(Sec.7014,Bmineas and Pmfessiam Cade:)The Cononsar's Li- . nee Law docs not apply in an owner of property who Wilds or improves comer,and. who contracts for such projects with a eonmcarts)licensed pursuant to the Conuances License law. ❑1 atn exempt under Sec. B&P C for this mason to Date WORKER'S COMPENSATION DECORATION I hereby affirm under penalty of petjuty arc of the following dalantionc 1 be-and will maintain a Certificate of Consent to Self-Insure for Workers Cont cation,as pmvidcd for by Section J]00 of the tabor Code,for me performance of the work for wM1ich this pctmit is issued. - ❑1 have and will maintain Workers Compensation Insurance,es myuimd by Section 3]00 of the labor Code,for the perfom eace of the work for which this permit is issued. My Workers CComPepsmio.I�m�PePoli Policy num am- My' C er. �j 11 CERTIFICATE OF E%EMPfiO FROM WORKERS' COMPENSATION INSURANCE (Tris section need not W completed if the permit is forone hundred dollars(SIM) or less.) I ccnify mat in the performance of the work far which this Permit is iseucd,1 shall not employ any person in any mannered as to become mb)en m the Wo lmrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should Wecom object to the Worker's Compcnvtion previsions of the Labor Code,you..at JO forthwith comply with such provisions or this Perm it shall W deemed revoked. z^ CONSTRUCTION LENDING AGENCY .N., Ihereb aRrm that them is a construction lending[—i y g agency ler the Performance of xthe work fur which this permit is issued(Sec.]09'!,Civ.C.) 6iA fender's Nam D z lenders Address U U 1 certify that I hale mad this application and sea that the above information is U,,r^ correct.1 agree to comply with all city and county ordinances and state laws relating to 0U Lu.-mmumax!proand hembyauthmiremesse. Live of this city toenarupon the above-mentioned property for imnify an keep es F a (We)ju agme a taw,indemnify and kap harmless the City of against said against V1 inco liabilities. of th,cmhend expcmeswhich they in any wayamus agvmtsaid City U z A PLICA T of thegranting of this Permit. , ^ APPLICANTE�AND �/ W�LCONPLY WITH ALL NON-POINT Issued by: Date SOURCE APO C si\ m o uf AppliwntiCoan' —� 9'� '' Did Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me appEcam m fuam building occupant sort or handle hvudous marenal *Di efined by the Cupertino Municipal Code.Chapter 9.12 and the Health and Safety e.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. []Y. 7140 Will the applicant or future building occupant esu equipment or Devices which!- g If a roof is installed without first obtaining an inspection,I agree to remove havardnus air contaminants as defined by the Be,Arca Air Quality Management all new materials for inspection. Ilt Cl Yes TWO 1 have mad the havardnus materials requirements under Chapter 6.95 of the Califor- niaHealm&Safety Code.See6om15505,25533ud25534,lundcmmdthatifthe Wilding j does not eurmlly haw a tenant mat it is po sihility to notify the occupant of the reyuimmenh aaTnast tpnara ,renenor ertifiem actcwc�./ Signature of Applicant Date O�e/r��age' '-'���Date" 0� All roof coverings to be Class "B"or better