08110021 CITY OF CUPERTINO
BUILDING DIVISION PERMIT pCONTRt1C OR ORMATIO;N
INV
BUILDING ADDRESS: PERMIT N0,
20373 VIA PORTOFINO AKEENA SOLAR. INC n8j10021
"R'S NAME: PERMIT ISSUE DATE
PHONE: SA CONTROL NO.
ARCH=fENGINEER: BUILDING PERMIT INFO
PHOTOVOLTAIC INST ON ROOF BLDG ELECT PLUMB MECH
0 0 0 0
fop LICENSED CONTRACTORS DECLARATION
U F 1 bcmhy.f firm that 1 am Hemmed under Pmona visiarchapur 9 memmaMing Job Description
^t1 with Section 70(111)of Division 3athe Busineu Bed Professions Code,and my license is
<�w in fall Tome and cfrea
Z Lmeve Cess Ue.• ��577
3
3 / Conuaam
7W ARCHITECTS DECLARATION
( 1 uMervand my puns shall be used as public recounts
;6U
k aro t; Liecmed Professional _
OWNER.BURDER DECLARATION
1 hereby aRrm that I am exempt from to Conusctor's License Law for the
COO fallowing mason.(Sauon 71131.5,Business and Professions Code:Any city or county
which mamma a permit m encored-alta.improve.dumaluh,m repair any surname
_Z< prior m its issuance.also requires the applicator format Permit to rile asigned statement
ss that beulicensed puramentmrocprovisions ofthe ConracmriLicemeLaw(Chapter 9 Sq.Ft. Floor Area Valuation
xF$ (commendog with Section 7000)of Division 3 of the Business and Pmfcssiom Code)or
y that he is exempt therefrom and the bum for An,alleged exemption.Any violation of
Section 7031.5 by any applicant ram.permit subjects the applicmt m a civil penalty of APN Number Occupancy Type
ret mart taw five hundred dollars(1300).
❑Lo An
Ne tonjuncl um is omntende withvngass0ic(core comprmamess
will Pr Ota work ands: he Ctmmmtinmdesm Law does
M N..of Required Inspections
Ad eraressfov Cdc:The antracmes License Law Baa art appy lf eco owner q P
propertywhobuilds,iimpmva Hereon,andwho doe souchworkhimselfed AmWe.
ehis
ham
umea,t eees,proNdrrI Na sahentisA entswit in notintendedofa roRaeA for Wei(.
builder.the building carom of pro inusaide did one Wild
of� prone or the case of
builder will love As buntco of proving that K did ret bdld or improv for purpose of
sale.).
❑L.as owner of the property,ser achadvely contacting with lived contractors an .
construct the Mica(Sec.704,1.Business ad Professions Code:)M Cotraemes U.
cense Law does art apply ban owmr of property who builds or improves thereon.An
who am.fm such prop.with aconuxmr(s)licensed purAmt m the Cotsmes
License Law.
❑IamammptunderSec ,B&PCfor Am--
a Dale
WORKER'S COMPENSATION DECLARATION
1 b ceby affirm mut r penalty o(perjuy one of the following dal Wimar
❑Ihaa odwie for
eCerufi7M a(Co Labor Chun.for n art. Ca of As
ssuo,r provided(pe by Sateen 3]00 a(the labor Coo.for tic peAormamu a(i
work for which this permit is issued.
I have Ad will maintain Workers Compensation Inst .as ramrod by Sectio
3MmAd Labor Code.for the palmonseco (Ne wmk for which this Puerto is issued
My Worker's Compensation Inane carrier and Policy number are:
ants: A i (� PalayNo.: 3`128255
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Thu sem.need that be cunplcuA irthe permit urorra hundred dollars(SI00)
or las)
1 certify Net in the perfonaae of the work fa which this permit is limed.L shall not
employ anypason many manmrmss an become subject to the Wafters'Compauman .
Laws of California.Dam
Appl cant
NOTICE TO APPLICANT:If,aRmr making this Cenificam of Exemption,you.Amid
become subject m Use Worker.Canpauetf sh provisions of the La1ar Codes yen most
.J O
EfonhwiA comply with such providom or Au portrait Nall d smarted meted.
'E y CONSTRUCTION LENDING AGENCY
w Ihereby affirm that them is a eomumdnn lending agency for Au performance of
roc work for which this permit u issued(SIL.3097,Civ.C.)
W Q Lattices Name
CL
_,z lenders AaGeas
J C 1 certify that I have rad this application had sum that the shove informado.is
fit. tonna-I agrtm In comply with all City and county ordinances and sum ren relating to '
-0 Wilding concoction,and hereby aoNorine representatives ofrhis airy m our upon the
4P7 vhove-mentioned property for impecuo purposes
(We)agree to save.indemnify and kap ham add Oe City of Cupertino against
f4/1 liabilities jdpn0nu,emu and ex mown which may in any way sacred&gaunt said"City
U Z in eamrganm of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO S.
it Re-roofs
Signature mApplianUConUselor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ac applicant or future building mcupmt Ann or Whole hvardou material
defmcd by An,Cupertino Municipal Code,Chapter 9.12,ad the Health and Safety
section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu ONo
Will the applicant or moue Watling occupant som component or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harsrdnm air conuminatu a definal by the Bay Arm Air Quality M-mgcmcnt all new materials for inspection.
District?
❑Ya ONo
1 hate road the bvudWs materials requirements undcrchapter6,95 mine alifory
w HWth&SafetyCde,lcaiw2550A25533a 25534.1.4. aM ifthe building
data ret currently Itace a comm der it u my napamibility m notify the occupant of thc
reyuimmcnu which mut be ma pdorm iMuanco a(a CcniOcam of Ocmpmry. Signature Of Applicant Date
Owner a awborixtl agent Dam All roof coverings to be Class'%W'or better
Dam'