08090193 CITY OF CUPERTINO =? -
BUILDING DIVISION PERNUT .ICON.RACTORj,NI<'QRMATION 2
BUIL LNG ❑ FSS: PERMIT NO. '
ALVES DR REC SOLAR, INC . 08090193
NER'S NAME: PERMIT ISSUE DAM
VICTORIA EVASHENK 775 FIERO LN STE 200 10/16/2008
PHONE:
SANITARY NO. CONTROL NO.
(888) 657-6527
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� = 0
woo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby allure that 1 Am licevcd under pmviSons of Chapmr 9(commencing p
Z wiNSccuon'/IX1U)ofDivLtion3ofNCBusincrsarWPra(cssioMUCodc,andmylicencis 3 .42 KW SOLAR PV SYS FLUSH MNTD ON ROOF
n,e y in full frit¢and often.(/I
se Clar
j(ate
License I-[.L_IJc.I \V b l
ns•u� Dau Contractor
eeqq ARCHITECT'S DECLARATION
t 2 I understood my plans shall W used As public retards
JyU
SAH Licensed Professional
OWNER-BUILDER DECLARATION
s� f I W rehy affirm
that I am exempt from ties Comractoes License law for the
COO following reamn.(Section RD 1.5,Business and Professions Coda:Any city or county
3$ which requires A Permit to cowmm.AIW.hepmvm,demu13314 v repmr my wuctum
poor to its issuance,also mquims the applicant for such permit to file a signed summcn
s< that he is licensod punmenn to me provisions of the Commences License Law(Chapter 9 Sq.Ft. Floor Area Valuation
yl-O (commencing with Sax-tion 7000)ofDivisionSofthe BusinessAnd Preens..Code)or $21000
$ that W is exempt Oemfmm and dse basis for Ne alleged exemption.Any violation of
Section7031.5bymy Applicant for.permit wbiMls me applies-'m A dull penalty of Number Occu ane e
con come man Ileo hundred ddhrs(M). 32631006 - p y�'p
❑I,u owner of tie property.n my employers with wage m Nov role compewtion.
will do the we*-end the a=..is not intended m offered for sale(SeeTD14.Business
and Pmfessmv Cade:The Contmmes License law dams act apply m an Awmr of Required Inspections
proPerty-w builds orimpmws thereon,and whodoesse wok himselforduough his
own employees,provided that well improvements are no'immnded araRered for sale.If.
bosvevcr,the Wilding or impmwnml is sold within arc Year of completion,the amen-
buildave ms-
Witter will he budof pmving Nu he did not build or impww for purpose of
sole.).
❑I.as owner of the property.am exclmively contracting with licensed contortions m
constnM the pmy O(Sec.7061.Business and Profeuims Code:)The Caotrwur's Li-
eve Law does am apply to an owner of property whoa Wilds or improvn do ern,and ,
who contracts for such projects with a conumtar(s)licensed puramnt An men Contractor,
License law.
❑I am neem under See ,B&P C for mis recon
40 mer Dam
WORKER'S COMPENSATION DECLARATION
1 Woolly air=under pevlty of perjury one of the fallowing rieclanuane
1 ham and will maintain a Certificate of Cmucnt to self--ivum for WorkersCompen-
wiun.uprovided(or by$radon 3]00 of me labor Code,fm the perfmors.of re
work:for which this permit is issued. _
❑1 have and will maintoin Worker.Compensation I...as mquitN by Section
37W.f the labor Cade,for me performance.(tie work for which mis pannh is Wood
My Work()Y�sf�Co(T'penWi.nlnsu,carriers-d Policy fq>9m1sursm )
Cartier.lC (I nOL Po11ry ���
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
most Aatim need cot An rmnpit"if ted permit is foraae hundred dollen(SIOO)
ser led.)
1 coolly,that in the performance of the wart Ire which this permit is issued.I Yeah am _
employ any person in my mannerso an to become subject to theWorkcoi Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If. for making this Certificate of Exemption,you should
become sublet m the Wortces Compensnlun pmvwons of the Labor Code,you most
.,O farmowith comply with such prevision or this permit shall An domed ked.
z CONSMUCTION LENDING AGENCY
I hereby dfrm that Nem a a construction lending agency for the perfurmana of
CC .tea me work for which mis Permit 4 issued(Sec.3097,Civ.C)
(s) Leerier,Name
Lenders Address '
az
U Q 1 certify Nat I have read this application and sum man the shove information is
II. F comact,I agree in comply with all city and county on inancea and sum Im raising to
0U building caeswnion,and hemby authorize representatives ofthi,city to cnur upon the
LL7 above-mentioned property for inspection purposes
(WA)agree to save.indemnify sod trop humlw the City of Cupertino against
F'f4A Iiabilidn,judgments,case ando.,.which may in any way.against said City
U z in consequence of the granting of this permit.
'--' APPLICANT U- ERSfAND AN WLLL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R/E CATION3. 16 . n�
( (2- 1, Re-roofs
Sip(mum ol'ApolicarrUCantrachor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will p(Appliant or future Wilding occupant nom or handle haratrious material
gorefund by me Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
ser. zss3z(.)]
Oy. ❑Na
All roofs shall be inspected prior to any roofing material being installed.
❑Yn
Will to applicant or future Wilding Occupant use equiproenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Amit ho>ardov air canumivnu an dcfned by me Bay Area Air Quality Management all new materials for inspection.
District]
DYAs ON.
I haus road me haasdns materials requirements under Chepmr6.95 of IW Califon- '
ma Health&Safctycodc.Scctimu 25505.25533 and 25531.I undcuum dmatifine Wilding .
dans not currently base a lenml Item i IIY m IwdfY tie Accown of me
mquiremcn�h M2sn be mem r .ecnifate of Occupancy. Signature of Applicant Date
i
oomerermmm;zea. n. Dose All roof coverings to be Class'1}."or better