01110055 (2) CI BUI I
BUILDING G DIIVIISINO
ONPERMIT CONTRACTOR INFORMATIO,
BUILDING ADDRESS: PERMIT NO.
10968 SYCAMORE DR. ECOENERGIES INC 01110055
OWNER'S NAME: APPLICATION SUB DATE
TOM KWAN 171 COMMERCIAL ST 11/13/2001
,/ ONE: SANITARY NO. CONTROL NO.
(408) 731-1202
C Q O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kC or
C- BLDG ELECT PLUMB MECH
v Z I_J _I L J I---I
S v= LICENSED CONTRACTOR'S DT:CLARATION"
I Z=C 1 NcrebySffirm ma 1 am ildcmcd under pmAsl°n.of Chapter 9 kmme
oneing ]ob Desert IIDn
„c y wnns''eenn troai+roi i n3,;,rmeBasinexnnarr°rc.xion,a le.anamyr«ase INSTALL PV ' SOLAR PANEL SYSTEM.
is in full race and effect.
O.uCn
Liccnsc Claes Lia,p
Dae mmnor
3 a.or ARCHITECT'S DECLARATION
.u
0, 1 understand my Plans shall be used as public records
at
cep C Licemod Pmfa mearid
OWNER-BUILDER DECLARATION
=' 1 hereby affirm that 1 am exempt from the Contractor' License Law LicenLaw for the
!'z a following rcesoa.(Section 7031.5,Business and Professions Code.Any city or county $42000
Y x o which require aperart m mnnmm,cher.improve,demolish,m repair any structure
or made,its issuance,also W,im,thea licaut for sueh nm hleasi WStatement - - - ---- —. - - —-- - - - - - -
dfgt h2 is Tice scE �•I,� Ag
puoismgiotheprwiaision 3hetheBufamots License I.� -s'l3 C�.:F'a-PI:Y 1V��ta Valuation
(commencing with t therefromo u)of Division 3 of the Business and ion Any vi Code) l,( _ Yt DD�sOO- P19 •tll.j., =t I . '
or tame i7 31.5 by
ytnacfmmonnd the hmi>far the cts,hd aen,.....Any l violation
of Sermon]031.5 five hundred
applicant fur o permit subjects the applicom m a civil peachy
°rnttmnreananrvennnarcadollars(Ssa)). 304vPNlS*D117E3I-I ELECTRICAL^ Occupancy Type
01,as owner of me PmPeny,urns,employees with wagcsns their sole compensation, 501 FINAL ELECTRICAL ENERGY
will me the work,and the Immure is not Intended or offered for sale(sec.]oa, 5 0 5 — FINAL E$F6�d ITRII&1 ktions'
`Business and Pr y Who
Curie:The Coe thereon.
.and w Low one,su not apply to if '
owner of property em builds or improves thereon,dna who docs such work himself
or hrou(o his own emoever.th ended that such comacIS I are not intended.or
'nBhcJ for sole:If,howeveF,the buildin - '- em is cold within one-ear of "... ... . .. .... . . .__.. . ____.... . .. _ . .. _... _ ..... ..._.,-. _ __ .. ..
ge IImProvcm y ,
icompletion.the°wnm.builej.will have the buNcn of Proving that he did not build or /
mprove res P,irPoee nr sale.).
co 1.e. fmcpropcmy,am exclusively contracting with licianstalcontorcouna In
construct the (Sec es]toBusiness Professions r f Code.)ThContractor x
i
License W doe-s not apply to an owner ofpropertywhobuildsorp thereon
'a
. and whorcontrucas for such Projects can t tort))lie need pursuant to me ..- .. .. _. ..._ �- (C✓/ ...__ .. _ _. .... .. ......_.
License Luw
0 1 am t U `� .• -
I a exempt and,,Sc B&P C f th reason yi.
< ,, ,•s •.sets DNC • ': ,: s /
WORRKERKER'S COMPENSATION DECLARATION
1herebyaffi ounderpenalty ofp<jaU oneofthe following declarations:
I hove gad will maintain a Cer ificam of Consent ti oelf-moure for Worker's
mpenxaion, oS provided for by Section 37M of the Labor Code, for the
performance of the work for which this permit is issued,. ,
01 have and will maintain Worker's Compcmaiion Insurance,as requited by,Section
bor
_ 37W of the laCode,far the performanm of the woik'or which this permit is
issued.My Worker's Compensation Insurance carrier and Policy number art:
Camel:- .•=.: . ,I ;i 'D I.P licy No.: I• .. .•�4. I .i^.^r ..t ,. nalLir
.. CERTIFICATION.OF EXEMPTION FROM WORKERS"
COMPENSATION ION INSURANCE -;+ °'
j his senldnnmd not be completed if tic vomit is for one hundred dollars .. '. L;'f - .•s'
($1001tnesa.) .
1 oeniry mat in the performance or the work for wmrn mix III,n is ::tied.I
'shall not employ any.person in any manner x°ax m become Subject to the Worken'
Compensation Laws of California.Dam
Applicant
NOTICE TO APPLICANT If,after making his Cenifcam of Exemption,you should • ' •'
Q Omxbensubjeta to the Worker's Compensation probisionx of the Labor Code,you must
fotinwith comply with such provisions or this permit shall M ammed revoked.
CONSTRUCTION LENDING'AGENCY - --
CL > '
'I
hereby aRrm that there is a cr onaciu n lending agency for the"'fotmunee
of the work
..i tanderk ,ffaor which this permn is I....J'(See.3097,Civ.C.)"
Qo ,.:.� ., .... ....... ... .. ... :.. .t... _ . .... .._. .__ ... _ _. _ ..
7.z Lend ..
AJJ _
V
-d. 1 c n fy that 1 have madthis pplica' J is that theabove information is t '
la. [.. correct.I agree to comply with all city and county molumnaa and slide laws relating
Q V to Wilding constmerion,and hereby authorize representatives of this city to enter upon
the al»vemarrommep m,my for inspection rmpma
w�•"-i y (We)agree to save.indemnify and keep harmleilnc City of Cupertino against
tp liabilities,judgments,cons and expenses which may in any way acerae against said
G v City in i uc
onscqnce of the granting of this Permit,
APPLICANT UNDERSTANDS AND W ILL COMPLY WITH ALL NON.POINT'
SOURCEREGULATIONS:'^" ' ^ ' " Issued by: Dale
Signamrc or ApphcamaCoatmcmr Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Nidi the applicant rt' Wilding Occupant store or handle mats xmocnal Type of Roof. .. _._ . . --. _ — — - —
as defined by he Cupero Municipal Cad Chapter 9.12.and h Health nes Safety „
Code,Section 2553200trl.l. t {r s t • 'y ' r .. .
Dyes, All roofs shall be inspected.prior.,to.any.roofing material being installed. ,.-.._..
Will the applicant m fimme lding occupant use equipment or devices which If a roof is installed without first obtaining an inspection;lagree to'remove
`mit hazardous air contaminants as defined by the Bay Area Air Quality Management
isaim^ all new materials for inspection. Applicant understands and will comply with
�"° all non-point source regulations.
'I
� Thave read me'h cad materials q encs and Ch pt r 6.95'of the
-
"
California Safety Code.Setions0. understand t
ifthebuilding does not otenant,
thmt itismyresponeiiblyto notify the
sdcidsm of the rrcquierssmus which must W ma prior to issuance of a Cefifcam
of
°"pp°"`y' •` Signature of Applicant Date_.-
Oisner°�omhor;acdagent - . . Data All roof coverings to be Class"B"or better
_C .i-
,.:: ., ._ .. .. _ OFFICE . .. _
CITY
DINurvsoNO
BUILDING ttNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10968 SYCAMORE DR. ECOENERGIES INC 01110055
VNF.R'S NAME: APPLICA ON SUr DATE
TOM KWAN 171 COMMERCIAL ST 11/ 13/2001
/
ONE: (408) 731-1202 SANITARY NO. CONTROL NO.
o e<z ARCHITECTMNGINEER: BUILDING PERMIT INFO
l-acO BLDG ELECT PLUMB MECH
v Z I j LJ L J L_J
LICENSED CONTRACTOR'S DECLARATION
izI hcrcbyaffirmmm lam licensed senderprod,ion,of Chapter9(commencing Job Description
w l-� w'in Smfnm7oXXfufDM,ion3oflha Bmv.r,,and Pmre,smn.neoda.ongmyran,e INSTALL PV SOLAR PANEL SYSTEM.
xf "in rwl cTomea Ir g /
O a O
Data s�Ft"da! Comuner
l 3 u N ARCHITECT'S DECI. T
1 understand an,plan,shall he used as pub is¢mals
��<
i m o o Lmen,ed rror<aaefal
GHam
DECLARATION
I hereby.(feta thatt Im
1. exempt from the Cssionsmr',License city
or for the
FY 2< (allowing maven.(Section IDJ L5,Bua ter, one Profession..Code:Any tiny ofcounty $42000
C_D ter 9
poorwhicht rets issu n permit re uimoue,aper,nt for such
demolish, fie pan any taruam<
ca yrior to,licenance.aBlat to the Ithe mmkilican for such pennh iofleaeLaw(ummem - -- --- - --- ---- ----lice_-_-
(co mincing wi pursuit tothcpro Do
d the Contractors Lind Prudential,
ode) 1'3C...��F,Ig�,p,u..n. Valuation
(commencing wish thirof in and,Dirisii, ort the Business and Professions Code) ` 'Y`L� V` \Y•tY!r ��Y " r l ,
or Shat he 7 31.5 b thcicftim-anJ the Me far the alleged exemption.Any violation
-of Salon a than by any applicant for a permit aobjc<m the applicam to a civil penally
Ior mer more man rive handled aounra a5B(o. 3 0 QPN NiFOtIESH ELECTR CAL'�' •� Occupancy Type
Dl,av owner of the p.,.,.or my employees with wages aslheirsole compsix,own, 501 FINAL ELECTR CAL ENERGY
-will do the work,and tnr,tmeture is not intended or offered for sale(sec.7044. 5 0 5 - FINAL E (i'F�TTtCs�do
Business and'Profions ea, Code:The Connector's License Low does not apply to an 1 i tions I''
owner of property Who builds or improves thereon,and who does such work himself
orthimprovements through his own employees.provided that such impvcmcs ere not intended or
oRercd Por salt.-IL bowev<r:the huildin —' tis sold within one- f -- - --- _- - - -- - - - - - --'
ge burden
of proving
y<arm .,.
oprove fn`the o oerf.s.1 der will have the buN<n of proving the be did not build or F 1111 A L E D _
improve purpoua _
lice._ mexclicensed
f The
OLonowner project
finitely,(Sm.7a,Buchuvelyeo contracting witCcdc:)sehe Contractor's
ontctorsm .. r
omwa the does
n (Scply to a owner sat and Professions Codc:)improves
ves to thereon. NOV9 O q o o1
License co does oat apply to an owner of a comm who builds s improves thereon. 1'1(1 Y d L
. aM who,,Livens for such pmjcn,.with a conpaaorts)liccnud.pursmm norther ... _. .. _ -. lice lice lice _ _ .. _.._ _.
Contmcturs License Law. � --�-� --� ��
D l am exempt under Sae' ,B&P C for this reason BUILDING"
an, Dae
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of perjury one of the following declarations:
I have and will"im imvin a Certificate of Consent to self-aum for Workers
ompnuaion, os provided Inr by Section Ptje of the Labor Code. for the
- performance ofthe work for which this permit is issued.
_ D I have and will maintain Worker's Compensation Insurance.as onfored by Section
37BB of the Lahor Cade,for the performancc of(he work for which this permit is
I-said MyppW ke/ Campen�t on(,sedan - r JPolicy numberart _ _ -_ _ _ lice
c m /-1Z��Pabey rvo. 3/3/#�6`I7lG'z- ,�,, ` �,.tt. -,.•: - - '- - � . ,t . r. .-----
' -C[RTIFlCATION OF E%EMPTION FROM.WORKERS',
. _. . . • _._. -.lice___. _._. lice_ .....___________.....___________._. .. _ _
'(Thiseenidn need not be compkmd if the permit is for one hundred dollars
($100)or less.)
.I certify Jhan in the performance nn the work for which this permir a Workers'
erk
Com nut anon ',a, Penn,in any manner so as to'become subject to the Wakeri '
Compensation Laois of California Data
Applica
NOTICE TO APPLICANT.lxCarrrmo,micthiso,mem amof Exemption.youshouldmoxf ,r '
becomeh comp y the Workers Cisions or
permit shall the Luber Calc,you must
C) fonhwith'camply with such provisions or phis permit shall. deemed rcvok<d.
Z2 ._ _ .. ._... ... .. ._ .. _ .._ . . lice ... ._ '- lice .. _
-ry •R4"° „'•!"'"CONSTRUCTIONLENDINGAGENCY ' '•'
a'7 "`"''1 hereby affnn the there is a camuueion lending agency for the p'n omance t '
,Q leof the work for which this pcm h is issued(Sec.3097.Civ.CJ 1 - _ - ._ .. ..... .. _ . .. _......
nder i Name
.. _ .:. ...,. . ._. .. ... .. _.
�.Z Lnedei's Address'. .. - _ a(•
V C 1 ecnify the 1 have read this applienion and sem that the above information is
Wo_E., correct,I agree to comply with all city and count,ordinances and sum laws relating n
U thealon thudding- atone un, dhereby nuehmi p rf es of th':city to tar upon
} fry the ebu x me t n d property forinspection purpose. •__--
�.d c, li n lovendemdpefy nJ keep harmless the City f e pert mbst.snn
h fubilt palliate o t d expenses wh ch ) any way gest.aid
C.) i City in comcq the gmnning m his f.C
_ 9OURCAN cc the
lV Cr,1PLY'N'ITHALLNONPOIYT Issued by: Date
SOURCE 'GUv y
signan ire orgpMlvanocontmamr Date Re-roofs
I{AZARUGUS MATERIALS DISCLOSURE,'� ). `
< win thesppliram or future Wilding oacupantsoie m naldle baardeu,nwerial Type of Roof .....-.. ..,....... - .. _ - _ ......
as defined by the CupertinoMunicipal Cod Chapter 9.12,and the Health and Safety
Code,Section 25532(a)', 4
^;
❑Ye, fl°lI All roofs_shall.be,inspected prior-to any.roofing material.being.installed.
Will the applicant e;future building occupant use component m devices which If a roof is ifistalled without first obtaining an inspection;I'agree.`to remove
emit haialloui air cantomiwn¢as defned by the Bay Arca Air Quality Managemem
vSdien - all new materials for inspection_ Applicant understands and will comply with, _
Dyes - all non-point source regulations: - -
I have'cad the hazardous materials requirements under Chapter'695'of me ._
Califarrtia Health&Safety Code.Sections 25585.25533 and 25534.1 understand that
f� s n 11Y �d a mw t nh t t mY mspon.b 113 t notify the
occupy f mr, ram t ch must t p t usu cc of a Certificam of
Gee a
Signature of Applicant Date_
✓-
Owner
awhonzcd agrnt Dam All roof coverings to be Class "B"or better
.,... .. .. . ,' _. OFFICE - -