07020158 CITY OF CUPERTINO
BUILDING DIVISION PERMITd)k�T �GTC)R I4RM�4TI€IN. `
BUILD rrU� eESS: PERMIT NO.
�U�Ui TONI CT AKEENA SOLAR, INC 07020158
PERMTT ISSUE DATE
r^ 'BR'S NAME:
)ON DISNEY 605 UNIJERSITY AVE 03/19/2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 867-0558
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
U1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL TION O F 16 ROOF MOUNTED SOLAR MODULE S
"C y in full force and effec 0 ':j�
)4z License Class •
F Date Contractor
A HITECfS DECLARATIO
7 C a I understand my plans shall he used as public records
)aU
U.F' Licensed Professional
OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
jC O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior m its issuance.also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $17000
t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L r that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more than five hundred dollars(5500). 31623104
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(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-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs 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 Contractor's
License Law.
C:]I am exempt under Sec. B&P C for this reason
.r Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Conscnt to self-insure for Workees 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
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Fz"J Yft l Policy No.: t
CERTIFICATE OF EXEMPTION FROM WO KERS
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,1 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 Workers Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fr tom. 1 hereby affirm that there is a construction lending agency for the performance of
(Y,> the work for which this permit is issued(See.3097,Civ.C.)
Wt�Q Lender's Name
�:)z Lender's Address
U C I certify that I have read this application and state that the above information is
H correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
HCP) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of tin f this permit. Date
►- APPLICANT W& S AND WILL COMPLY WITH ALL NON-POINT slued by:
SOURCE GUL
X1-6 Re-roofs
Signature t/Comractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Loof
Will the applicant or future building occupant store or handle hazardous material
as dcftncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
It,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes KNNo
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safctyc ,Sections 25505.25533 and 25534.I understand that if the building
docs not current nant,that it is my responsibility to notify the occupant of the
requirements i be toissuanccoI CcrtificatcofOccupancy. Signature Of Applicant Date
6 All roof coverings to be Class"B"or better
Owner or thorned agent Date