08090141 CITY OF CUPERTINO ak%* a x=>x.
BUILDING DIVISION PERMIT ikc6 ,","CTC?R INkOOtM4�TION .
BUILDING ADDRESS: PERMIT NO.
21577 VILLA MARIA CT TBD — TO BE DETERMINED 08090141
ER's NAME: PERMIT ISSUE DATE
TINA WOO 10/02/2008
NE: SANITARY NO. CONTROL NO,
ARCHIE TleNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION - Job Description
C 1 hereby aaffirmWu 1 am licensed uMer provisions of ClesPler 9(mare—ing
WwiNcc
stlon10f11)ofDivislon3ofilreBusnemaum
and Iice�xia INSTALL SOLAR PANEL @ ROOFTOP. PAINT TRIM TO
O'n infullforteanaleffect
;gz License lata Lie.• O1'- MMATCH
R9Dam ARCH ZLARAoN ROOF COLOR.
o,
U
k 1 underwnd my plata shall W used u Public te<orNs
Wt;� Licensed Professional
3 OWNER-BUILDER DECLARATION
I 1 Wmby aRrm Nat I am exempt from the Convector.Luenm Law far Ile
O O following mama(Sidon 7(1313,Business and Professions Code:Any city or county
R 51� which no eims•permit to contig alter.improve.dem Wfeh,Or minor any strmum
prior at its luuarc..lsu ratio.deapplicant for inch permit to file a signed smencit
-sZ< that heisftcar dpunuantmlheprovisionsoftheComecon''sLJccvclaw(Chapter9 Sq.Ft. Floor Area $5000 Valuation
yF0 (commencing with Sttdon 7000)of Division J of to Business and Professions Code)of
t�$ that he u exempt therefnm and the buds for the alleged exmpuorm Any violation of
Secdam 70313 by arty applicant for.permit subjects the appliam to a dvll petty of34 Number Occupancy Type
not mart than five hutalmd dollar(t300k 35623059 .jy(
❑Lothwar .the pmpmy,oe 13emmemadwithwagesuNei(Sec.c .Became
and do Nework and Iht heCumtsrots LMW mawde(asaic(sec.7066,Became
oral Property
who
Cada:The.rho mea Lit ho does dao not apply m an owner is Required Inspections
PropertywhrhWdsmireProw thump( it ho aresruineg himselfadIhmugh h1.
ow ever. yeWiass.Prog Or improvement Nal e is improvements in not urofintended mplanioroffsea The role tt,
however.me building a enrovints vela within arc yeti of c prove for
Nepose of
Wilda will have the buNen of paring Out W did rot Wild a improve for Purpose a( ,
tile.).
❑1.u owner of the property am exclusively convecting with licensed contrxtnrs he
canstnm the Project(Sec.70".Business and Professions Cade)The Caorveemrs Li-
cense law does an,apply m an owner of property who Wilds or impta.Merton,and
who contracts for such projects with aeonwmoru)licensed Pursuant m the Centimeters
Law.
amamWitundusee .BBPCfar Nurtaxm
nes
Date—
WORKERS
au
WORKERS COMPENSATION DECLARATION
I hereby air=under penalty or perjury me of the following dedaudions:
I have and will maintain a CaGfiae or consent he if-imem far Wodues Campos.
satire.u provided far by Section 3700 of the labor Code,far the Performance of me
work far which Nis permit u issued.
❑1 have utd wili maintain Workers Compensstion Insurance,u required by Section
371D of am labor Code.far Ne performance of Ne wort for which this permit is issued. -
My Workers Commutation Insurance artier snd Policy number are:
Carrier: ' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissecaon mad not W compmea ifthe permitu fame hundred dollars($100)
or len)
1 certify that lo the perfurmame a Irk work he which this Permit ts issued.l shall am
employ anypersen in any mmmrw u W become subject to lW Workeri Compmauon
Laws of Califand
Applicant
NOTICE TO a an the
:es alum making CcnlOae of Eaata tion,yon et
becomesubjectm hi Wohe variations
Comperwtianemiribul of thelabs Cara,you meet
.,O forthwith comply with such povidons ar Nu pewit shall W acemW rewkM
z v-"
CONSTRUCTION LENDING AGENCY
I hemhy alRnn that Vert Is a comuuctim lending agency for the p:rformence of
fY,
the wish for which this permit Is Wood(Sec.3097,Civ.C.)
W�Q lenders Name
•J z L.ename.Address
U O I certify that I haus mad Nu application and sum Nu the,above information is
Ig, arRa.I agme to comply with all city and caWty md111NRa and slam laws xlating to
O building construction,and hereby mNwim reptoxnsuves of this city to enter upon the
W .Cove-mandoad Property far inspection Proposes.
136 (We)agree to save,indemnify and kap harmlvs the City of Copertinu agunsl
h liabilida,jedgments.costs and apcmea which may lo anyway amtre against wild City
U z m eonseqarme of Ne gamins of Nis permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT' Issued by: Date 0- Z
SOURCE REGULATIONS.
10)-2_1 Re-roofs
urt
Signuof ApplicandConwcm ,r Data 11
xnznRDms ldmCocNs am
Type GfRoof
WIII the,CoWn for(alum Wilding occupant nae or audile Health andSafrmaterial
rand by Nc Cupenim Municipal Code.Chapter 9.11 and Ne Ha1N and Safety
ere,Section z5
s3
2
(.)7
❑Yu All roofs shall be inspected prior to any roofing material being installed.
�Na
Will the applicant or fuuoe holding accupant ase equipment a dedm which If a roof is installed without first obtaining an inspection,I agree to remove
it ha>ardnu air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Diurict7
❑Yes QA-
1 have read the hvaed<wsmamrials rtquiremcnts under ChaPmrd.95 of Ne caller,
25517 vena 15534.1 uralcnwal NuifNc building
does rot comndy haw a U^•^L Nat it u my responsibility to notify Ne occupant of tW
mgnmmcn hick must W met pier uS of a Cudriam of
�v7Vv Signature of Applicant Date
101 V Ower or authorized.gem All roof coverings to be Class'%?"or better
am