07050106 CITE'OF CUPERTINO
BUILDING DIVISIONPERMIT + �lllTlA �' ?R �(? tMTI4�lY`
PERMIT NO.
BUILDIlNUG JAI�EIVICKSBURG DR MC SOLAR ENGINEERING 07050106
l V PERMIT ISSUE DATE
OWNER'S NAME: 06/13/2007
DAVID PIETROMONACO 2362 WAI�SH AVE
SANITARY NO. CONTROL NO.
NE: (408) 496-6226
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p o LICENSED CONTRACTOR'S DECLARATION Job Description
i V s= I hereby affirm that I am licensed under provisions of Chapter 9(commencing INSTALL��TION OF PHOTO VOLTAGE SYSTEM W/BATTERY
Z U with Section 7000)of Division 3 of the Business and Professions Com and my license is
t=y in full force and Li eYfFc�.D Lic.M 116 d BACKUP ON SFR. BATTERIES ENCLOSED OUTSIDE OF
v�Z License Class
p
Date . / z7 Contractor RESIDENCE.
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
iyU
o y Licensed Professional
OWNER-BUILDER DECLARATION
e1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<0 a! which requires a permit to construct,alter,improve,demolish,or repair any structure
t—V prior m its issuance,also requires the applicant for such permit to file a signed statement t;q-Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $16500
t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCCll Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 914 0 0 7 AgbT Number Occupancy YP
not more than five hundred dollars($500).
❑1,as owner of the property,or only employees with wages as their sole compensation,
will do the work and the structure is notintended or offered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner- A
builder will have the burden of proving that he did not build or improve for purpose of .�
sale.).
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
0 I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: 1
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers C pe cation Insurance c 'er and Polity number arc:
Carrier: /` Poliry No.:/2 y V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
ZCONSTRUCTION LENDING AGENCY
,
I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
(J I A L.endcr s Name
aLenders Address
U C) I certify that I have read this application and state that the above information is
LL H correct.1 agree to comply with all city and county ordinances and state laws relating to
O building construction,and hereby authorize representatives of this city to enter upon the
UWabove-mentionedproperty for inspection purposes.
G4 (We)agree to save,indemnify and keep harmless the City oC Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. :A Date
APPLICANT UNDERSTANDS PLY ALL NON-POINT Issued b}
;SOURJCATIGNS.
Re-roofs
azure of ApplicanVContrxtor Doc T Of Roof
HAZARDOUS MA CLOSURE
Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yes 0N If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? /
0 Yes ❑No
1 have read the hazardous materials requirements underChapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534-1 understand that if the building
docs not currently have ant.that it is my responsibilit,to notify the occupant of the Date
require nest be met prior to i f a ficate of Occupancy. $1 atur;of Applicant
�-e) All roof coverings to be Class"B"or better
ncr or authorized agent Date