08100197 CITY OF CUPERTINO7
BUILDING DIVISION PERMIT CONTRACT(:TRINI<'(}ItMATI(7rN ..
BUILDING ADDRESS: PERMITNO.
10398 VISTA KNOLL BLVD REC SOLA IN(` ogioni (47
R'S NAME: PERMIT ISSUE DAME
PHO RTFATfWO�.... CONTROL NO.
(888) 657-6527
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION Ib Description
rd 1 hmeby affirm dual 1 am tise.ed under Pmsisians of Chapter 9(wmmencOe5Cr1
in{ p -
rith Section 7Mu)of Divisors 3.1'the Business and Professions Code,and my license is
+ H in full fmcaameffeaSOLAR PV SYS FLUSH MNTD ON ROOF ,
a=q ties ., Lit, �Sb184
^t7 Dau �1—I — Camm
recr ET. .Q 1 Svc.
`1` ARCHTECCS DECLARATION
a U I understand my plans"I W used.Public records
ice
Uccedcd Pmfcssional
3 OWNER-BUILDER DECLARATION
ClnTION
s�0 f i hereby.Sect that 1 1. exempt from tle Cssions os e:11 My
Law for IN
O O following mason.($redact 7 construct,
Busncss and ere.de Professions Cmc:My city or county
$ which requires•permit t corswc4 applicant
impwse,demolish,rare pair ed aauctm
_z i prim t its issuance.also rtgo th,tie applicant forwch permit m file m Law suumenl
< thm he is limned putmammtic providers of the Contractors llccmms law lLTapter9 Sq.Ft. Floor Area Valuation
x�g (commencing with Section 7000).f Division 3oftle Beat.and Profession.Code)ur
— that he is exempt therefrom and IN basis for de alleged meraptian Any violation of 821000
Section 7071.5 by my applicant For a Permit subjects IN applicant the a Civil pesulty,of APN Number Occupancy
ren mom door five hundred dollses ISM 32613060 . 00 p y Type
C Laowner ofue property,vmy employees with"Sum theirsulecompensadon,
willdotlewo mdthasw=u mtin=&doraRered(vsale(Sec.70R4,Busircm Re/�uiredIns Inspections
and PNN ICSLOCmc:The ContrKmrs LImM1Y Law does Out apply an an manner of y p
property who Wilds orimpmves themor,and who does suchworkhimmlfosduough his
Own employ=.provided that=ch improvements tie not intended oraRered for We.If.
however,doe Wilding or improvement is mid within one year of completion.the owner,
Wilder will bave the burden of proving than he did not Wild or Improve for purpose of
ale.).
C 1,a awns,of live property,am exclusively contracting with lice••!conasuman an
com enta the pmjm(Sec.7044,Busiav sm Profesdoed Code:)The Conlracur's U.
terse law d=not apply Or an owner of property who Wilds or imprown demon.and,
who convects for such projects with a contractor(s)Iimnaxd pursuant an the Contractor's
License Law.
lam exempt under Seta ,B&P C for tltismasan
Dau
WORKERS COMPENSATION DECLARATION
1 hereby afrum under penalty of perjury oro of the following declarations:
C 1 have and will maintain•Certifimt ofConxnt to self-inure falamkees Compen.
mesion.as provided for by Section 3700 of the Labor Cmc.fos the performance of the
work for which this permit is issued.
C 1 have and will maintain Workers Compensation Insurance,as required by Semi=
3700 of doe Labor Code,for the No...of de work for which this permit I.issued.
My Wo s Com1ppe�_edadue Imumme cartiv and Poliryyp'umN art:
Cartier: 12Qipf tall put--,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(NlsacNm need Ott x canpleud If the permit is forme hundred dollars(SIM)
orkxv)
L mnify that in the performance of the work for which this Permit is issued,l shall not
employ any person in any manner an an u become subject t the Wartcn'Compensation
Laws of California.Due
Applicant,
NOTICE TO APPLICANT:If after making this Certificate of Exemption,you should
Income subject to the Workers Compensation provisions of the labor Code,you must
.J z fomewimh comply with such proviso.or Chis permit"I W deemed rtvuked.
zCONSTRUCTION LENDING AGENCY
`
[—i 1bomb,affirm that Nem is a construction lending agony,for the performance of
fk> the work for which this Puma 1,issued(Sec.7097,Civ.C.)
QLenders Name
z Lenders AM.
U O I maify that 1 law,mail this m ullication and some don the show ofmmason is
ly ^ cormcl 1 agree to comply with all city and county atdinan=and sum laws relating u
.�iV' building construction.anher
d eby wthu orice representatives of this city enter upon do
Gq aline-mcntiaaed property foe inspection purposes _
pry (We)agree or ave,indemnify and ksep harmle.the City of Cupertino against
ti liabilities.judgments,costs and expenses which may In any way mento against aid City
U z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WI MPLY WITH ALL NON-POINT Issued by: Date
SOURCE R LATIO
Re-roofs
S' aturt
pyla H o RDOUS MATERIALS DISCLOSURE at Type of Roof
Will cep canmur forum Wilding occupant atm or handle Incautious material
Bond by de Cupertino Municipal C Chapmer 9.11 and the Heald and Safety
.Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
\ CYm o
Will the applicant or farm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvallom air contaminants ss dcfced by the Bay Arta Air Quality Management all new materials for inspection.
Distney
CYcs y
I have read the haemm
dousaenalsmquimmems under Mpurli.95 of ueCsifor-
.isHwlth&SafctyCodc,Seems 25505,25537 and 15534.1 understand thetifthc Wilding
d=not currently haw a enant dot itm edibility no notify Cho occupanm of the
requirements which to a acc ar.Cmif
arca Signature of Applicant Date
0 nv or truth cd Win, Dow'
All roof coverings to be Class'R$'or better
r