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07010138 CITE'OF CUPERTINO C1TtAGrORIC1ItMTI©N•= BUILDING DIVISION PERMIT PERMIT NO. r iL IxG ADDRESS: REGRI D POWER 07010138 0571 N PORTAL AV PERMIT LSSUE DATE OWNER'S NAME: 7 STEWART CHESSEN 1624 DELL AVE SANITARY NO. CONTROL NO. ,NE: (408) 927-0811 BUILDING PERMIT INFO ARCHITECT/ENGINEER: := BLDG ELECT PLUMB MECH 0 0 0 0 i p a LICENSED CONT RAC IOR'S DECLARATION JOb Description U t= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ;z� with Section7000)ofDivision3oftheBusinessandprofessionsCode,andmylicense 3 INSTALLT.TION OF SOLAR PHOTOVOLTAIC SYSTEM ON t>y infullforceand` (yrB Lieu O RESIDENTIAL ROOF ? Lice CI t Date ' '�� Cttnlractar �W ARCHITECTS DECLARATI I understand my plans shall be used as public records )yU U.y Licensed Professional -a a OWNER-BUILDER DECLARATION 1 hereby alTrrm that 1 am exempt from the Contractors License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any swcture Valuation u rn prior w its issuance,also requires the applicant for such permit to file a signed statement j Ft.Floor Area -Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $26791 t=G (Co.mencing with Section 7000)of Division 3 of the Business and Professions Code)or i thathe is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 1 6 3 0 0 9" Number not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.It, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason 0 i am exempt under Sec. OwnerDate ER' WORKS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: l1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- tion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workefs Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor Compensation Insurance,amcr and Policy number arc: Carrier. Policy No o t�')- CPc�75 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not 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 Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z►-+ CONSTRUCTION LENDING AGENCY H.�. I hereby affirm that there is a construction lending agency for the performance of Cd> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name CI. Lender's Address I certify that i have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the above-mentioned properly for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Mliabilities,judgments,costs and expenses which may in any way accrue against said City U zin consequence of the granting of this permit. Date ►- APPLICANT NDERSTAN SAND WILL COMPLY WITH ALL N-POINT Issued by: SOURCE - o`lRe-roof:; Signature o t�ONS. ctor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertinou X. Code.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes le If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future budding occupant use equipment or devic devices all new materials for inspection. emit hazardous air contam�()us as defined by the Bay Area Air Quality Management District? 0 Ycs No I have read the hazyaterials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCode,Sections 25505.25533 and 25534.1 understand that if the building docs not c oily have a ten that it is my responsibility to notify the occupant of the Date require en w h us[ a prior to issuance ofaCertificate 9f Occup Signatu,-e of Applicant b All roof coverings to be Class"B"or better Ow or authorized agent IDatc