08100132 CITY OF CUPERTINOi w� ^�sr'+a.,f `B•a '" rt -
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BUILDING DIVISION PERMIT CON�TRAGT(TRINk'(}RMAT'I(}N
BUIIDING ADDRESS: PERMff NO.
19714 AMHERST DR TBD - TO BE DETERMINED
OWNER'S NAME: PERMIT LESUH DATE
O§�NG ARTHUR j AP40 RUT!i F
NFF StAX&A` O�. v v CONTROL NO.
TDTICT
ARCHI7ER7ENGINEER:
BUILDING PERMIT INFO
'BLDG ELECTPLUMB - MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm land 1 am lixnurl-min'provisional of Chapter 9(moan--ng P
with Section 70(10)of Division 3 ofthe Buumm;and Prefeuimn Code,and my licemu is
.Z2 Ie0c11 Tome aha e(fecL� 913366 PHOTOVOLTAIC SYSTEM-1'8 SUNTECH, 170W MODULES, 1
j$z Licence Clhy� fY.L
Dam /fJ conusemrLJ f T SMA SB300 INVERTER
ARCHITECTS DECLARATION
9a 1 ummnund my Plana Nall be and m Public record,
pyU
LLL Licensed Professional
505 OWNER-BUILDER DECLARATION
cmuna.
t o Z 1 hemby alit%that 11- eaempt from O r Cmmnctors :Any c Law for the
O 0 following uhm,remorma (Section 7831.5,e. lWr. and improve,
de ons Cale:My city or clan
$f<i which rtquitea a permit re cores the a@c improve,h permit
ermi h,nr a pair any ewmam
priori its issuance.aBu requires lM applicant for such pemitm fileasigmdsumment
pp UwhiscingwitSectantm0MofDivisim3of eBuxnce;adanselaw ;Cock)9 Sq.Ft.Floor Area Valuation
Y� chime is curmptb Section ands( inch n3 theaeged mend PmfMy vi Codc)of
3 That he u eaempt therefrom and We buss for We alleged esemptioa My vlolatiun of 820000
Section 7031.5 by arty applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not ream that five hundred dollen Q500). P Y YP
❑I,uowtar of We ptopenY•ormywpl%cn wWm mgnsutk'vale eanpensatim, 31628019 . 00
will do Wemark andthe 1huCom ants Licard Law doian,aply in an.Bner of
and errwho W Cnda The contmemrs License{ave dna Tat apply m an ough is Required Inspections
property who Wilds ored mat s ch imp,and wM me not in work oroffene through his
ownemploy¢,prugdnd thatsuchimPtovemrnuartnot immdedaoeetM for sale U.
r-
helium da building orden ofp.entIsveldwithinarcyearofcomolefortheownm-
builder will have tM burden of proving that be did ret ddld bar improve far puryose of
OIC.).
1,as owner of the property am eacluively contracting with lure ed mnttecm;to
construct the project(Sec.7014,Baines;and Prfessiou Code:)The Conuaemri U.
moa Law doss bee apply to an owmr of property who builds or improves Wemem.and. .
who comma;for such projects with ammrutor(s)licensed puraaaml m We ContraCWra
Lkeve Law.
❑Iameaemptundm See .BdPCfm Wiareamn
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby afim mmnr penalty of pmjmy arc of the following declantione
I haveamd will maintain aCrsOfam,of Co icnl m self-Insure for WmmrsCanpen-
sauon,as provided for by Section 3700 of We labor Cade.for dm performance of the
we*for which Nis permit is bound.
1 have and will maintain Wormes Compensation Insurance,an mxNm d by Seaton
3700 MNe tab¢Code,for the performmhce of We work for which da,permit is issued
My Workers C�omtpe�mato hour. mien and Policy number -
Carrier. S/�/Pi- QOM Polley Na.: 37 O6 7
CERTIFICATE OF E)(EMFnON FROM WORKERS
COMPENSATION INSURANCE
(This seNan hand on bC completed Vote porch is fa orc hundred dopa;($100)
or hal
1 cent(-v,that in We performance of We work for which Wis Permit is imuN,l mail not
empl%any person in my mmmrm as W become subject in We Worken'Campeunimm
Laura of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject r the Warkcls Compensation provisional of me Labor Cade-you must
O forthwith comply with such pmvitom or Wu permit shall W deemed revoked.
zy CONSTRUCTION LENDING AGENCY
[r IherebY affirm drat them iaacoumatinn lending agency for We perfunnanmuf
C We were for which this permit Is bound(Sec.3097,Civ.C.)
W Q Lcndars Name
Z fenders Address,
U Q 1 certify that I have rod thia application and sum put Lha above informailun u
{I. E cmmo"v I agree W comply wild all City and county adinart¢s and sum laws beating to
.� building conswction,my auWorim mpmsemafives of Nis city¢enter upon the
d hereby
W Don-mentioned property for inspection puryuna.
g� (Won)agree to Ove,indemnify and gap harmlev the City of Cupertino agaiut
Try liabilities,judgments,eau arm uperues which may in my way•ccna against and City
V Z In eommqumcC of the granting of this permit.
.. APPLICANT NDERSfANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE LAT�oNS.
tiL Re-roofs
Slgwure,al'Appliont'Conuaaer Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building eccupmt voce or Inhale brearclas material
O defuad by the Cupertino Municipal Cay,Chapter 9.11 and We Health and Safety
Code.Section Z532W7 All roofs shall be inspected prior to any roofing material being installed.
Oyer myth
Will the applicant or future building oecuPa.,use equipment W&vim which If a roof is installed without first obtaining an inspection,I agree to remove
emit herardnua air cmmamimma as defmnnd by We Bay Ama Air Quality Management all new materials for inspection.
Dlaria7
❑Yea
I have read the W000duumamdab regflemna mulmChapmrb.95ofWeCalifor-
maHerm&SafelyCode Sccuons25505X533 and V5534.I undmund dauifthe building
docs Out currently have a Imml Won it is my reryonribility W badly the eccvpatt of We
rcquinernhacb mwaWmapdormiaamecofaCcnillamof0c mc. Signature of Applicant Date
�4-C /0-2 x'-08
All roof coverings to be Class'%?"or better
Owncref.affichrid egem Dam'