07010178CITY OF C;UYr.icl llry
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
11395 CANYON VIEW CL
OWNER'S NAME:
HOPKINS JOHN N AND CAROLYN S
,NE:
ARCHITECT/ENGINEER:
m ZFD
LICENSED CONTRACTOR'S DECLARATION
0
uI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z ection 7000) of Division 3 of the Business and Professions Code, and my license is
y force and cff t S
v� ZI Lic. #
ContractorRCHITECCSDECLARATI NI understand my plans shall be used as public records
Insed Professional<OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
noing reason. (Section 7031.5, Business and Professions Code: Any city or county
requires a permit to conswct, alter, improve, demolish, or repair any structure
a ' Nkl its issuance, also requires the applicant for such permit to rile a signed statement
-?ae is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
F=- (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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ I, as owner of the property. or my employees with wages as Weir sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does 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.).
❑ 1, 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-
reon. and
who contractLaw tsscfor such pnot roje
cts cts with a can owner ofontractor(s) (s)1 licensed pursuanperty who builds or t to the roves Contractor's
License Law. B & P C for this reason
❑ I am exempt underSee
�z
0
z
._.
W '.. '
C1. Q
�:) z
UO
H
H
U
I hereby affirm under penalty of Perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure forworkces 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code. for the performance of the work for which this permit is issued.
My Worke�s Com � a�sation Insurance carrier and Policy number
are:
Carrier. (w a :7CER7zATE M; PI ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars (S I Oil)
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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a constructinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lender's Namc
Lender's Address
I certify that I have read this application and stale that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
J building construction, and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in anyway accrue against said City
Z
PERMIT NO.
RENEWABLE E14ERGY CONCEPTS 07010178
T NC_ PERMrr ISSUE DATE
1236 LOS OSIS VALLEY 7
SANITARY NO. CONTROL NO.
(888)657-6527
BUILDING PERMrr INFO
BLDG ELECT PLUMB
Job Description
GROUND MOUNTED SOLAR PV SYSTEM 6,480 HU
35627022:
OwnerDate
WORKER'S COMPENSATION DECLARATION
in consequence of the granting of this permit.
►' APPLICANT UNDERSTANDS AND WI MPLY WITH ALL NON -POINT
SOURC EGULAC(1
Date
corSignee Appi
HAZARDOUS MATERIALS DISCLOSURE
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)?
❑ Yes o
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
District?
C] Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor
nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building
does not currently have a tenant, that it is y sponsibilily to notify the occupant of tht
rcuuiremcnis which must be,pe(tpcior to s an c of a Certificate of Occupancy.
Owner or authorircd
Date -
Floor Area $30000 Valuation
4 Number Occupancy Type
Required Inspections
C
Issued by: S
Re -roofs
Type of Roof
MECH
All roofs shal' be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new mater als for inspection.
Signature of applicant
All roof coverings to be Class "B" or better
Date