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CITY OF CUPERTINO
DIVISION PERMIT
.7-7777 -777777777-_-
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BUILDING
BUIL 1 DRESS:
G Pqq
PERMIT NO.
TTA ROSE GARDEN LN
REGRID POWER
07010139
OWNER'S NAME:
PERMIT ISSUE DATE
NANCY GABRIEL
1624 DELL AVE
02/06/2007
/NE:
SANITARY NO. CONTROL NO.
(408) 927-0811
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis
INSTALLATION OF SOLAR PHOTOVOLTAIC SYSTEM ON
in full force Ifec
License Class — Lic. ff —
RESIDENTIAL ROOF
Date -a' .L .. 1 7 Contractor
ARCHITECTS DECLARATIO
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for such permit to file a signed statement
Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
7000) Division 3 the Business and Professions Code) or
$26791
(commencing with Section of of
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
617 qP
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not mere than five hundred dollars (x500).
3 6 0 0 5
Q I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
q P
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 er through his
own employees, provided that such improvements are not intended or offered for sale. If,
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.).
O I, 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 contractor(s) licensed pursuant to the Contractor's
License taw.
❑ 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
wprk for which this permit is issued.
I have and will maintain Workers Compensation Insurance, as required by Section
00 of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation^ hinttraancc= and Policy number arc:
ieir >r,4+� Policy No (�
Carr.�
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
' forthwith comply with such provisions or this permit shall be deemed revoked.
" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
y the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
" correct I agree to comply with all city and county ordinances and state laws relating to
" building construction. and hereby authorim representatives of this city to enter upon the
above-mentioned property for inspection purposes.
61 (We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, Jud cots, costs and expenses which may in any way accrue against said City
in conseq nce f the granting of is permit.
APPLIO NT AND A D WILL COMPLY WITH ALL NON -POINT
Issued b is Date
SOURCE R S.
Re -roofs
Type Of . ZOof
Si of App lieanUConvactor le
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mu icipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
All roof:. shall be inspected prior to any roofing material being installed.
0 Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants defined by the Bay Area Air Quality Management
all new I naterials for inspection.
District?
C] Yes Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand thatif the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
require w ch must prior w issuance of a Cenificau: OCToyr.
Signatur ° of Applicant Date
-� = 1 (0Cr
All roof coverings to be Class "B" or better
Owner or authorized agent TDate