07040247 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � 1 €TRAt? i� }IMTIf��1�,
PERMITNO.
BU(Lq�3>��PsONA CT REGRID POWER 07040247
L L �5 Kfll�1 PERMIT ISSUE DATE
'SR'S NAME:
JHRI MICHAEL A 1624 DELL AVE 05/09/2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 92-'-0811
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
� 0 0
i 0 Q LICENSED CONTRACTOR'S DECLARATION Job Description
W
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
�Zw with Section 7000)of Division3ofdteBusinessandProfessionsCode,andmylicenseis INSTALL SOLAR (PV) SYSTEM ON THE ROOF OF A SFR
in full force and of
j ? Licensc Class '� L•g
i F Date Con
ARCHITECTS DECLARA
7 a< I understand my plans shall be used as public records
)4U
U.t-1 Licensed Professional
OWNER-BUILDER DECLARATIO
)y I hereby a1Trm that I am exempt from the Con or s Liccnsc Law for the
C p 0o follow/ndd
reason.(Section 7031.5,Business and Prof ons Codc:Any city or county
C20
=ff whichuires a permit to construct,alter.impro ,demolish,or repair any structure
prior tissuance,also requires the applicant f such permit to file a signed statement t'q Ft.Floor Area Valuation
that helicensed pursuant to the provisions Contractor's License Law(Chapter 9 `' $35000
2 t- (commcing with Section 7000)of Divisi 3 of the Business and Professions Code)or
i that hexempt therefrom and the b for the alleged exemption.Any violation of
Sectio031.5 by any applicant for rmit subjects the applicant to a civil penalty of 3570106' .
i �Number Occupancy Type
not mthan five hundred dollar ).
❑I, wner of trite property my employees with wages az they sole compensation,
will de work and the s ure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Psions Code: Contractors License Law docs not apply to an owner of
propeho builds or' proves thereon,and who does such work himselfor through his
own eloyees,pro ded that such improvements are not intended or offered for sale.If,
howethe buil • g or improvement is sold within one year of completion,the owner-
buildill ha the burden of proving that he did not build or improve for purpose of
sale.)❑1, ner of the property,am exclusively contracting with licensed contractor to
the project(Sec.7044.Business and Professions Code:)The Contractor's Li•
w 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 Contractor's
License Law.
0 1 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:
0 Ilia and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
ZIfor which this permit is issued.
have and will maintain Workefs Compensation Insurance,as required by Section
of the Labor Code,for the performance of the work for which this permit is issued.
My Workef Comp nsaC sumnce mer and Policy num r arc:
Cartier Policy No
CERTIF1 A E OF EX P ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollar($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any on in any mann so az to become subject to the Worker'Compensation
Laws of =ate r/
Applies •'' 51'
NOTICE TO XPPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
(�►�-� I hereby affirm that there is a construction lending agency for the performance of
lyi 5 the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
Lender's Address
2
U C—) I certify that I have read this application and state that the above information is
►c correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authome representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
GL (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z Aconsequence
PL CANTeof the granting of UNyyDERSTANDS Ars permit.ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sou�lG� � Re-roofs
Signlu of Applicant/Contrctor lire Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni ipal Code,Chapter 9.12,and the Health and Safety
Section 25532(x)? All roofs ;hall be inspected prior to any roofing material being installed.
0Yes No
If a roof i;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 contamiZN.
find by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Yes
1 have read the ha72rdaus materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safety ,Sections 25505,25533 and 25534.I understand that if the building
d of urrcntly h a tenant,that it is my responsibility to notify the OTOR
t of the
uirc met prior to i stance of a Certificate of $Ig ture of Applicant Date
All roof coverings to be Class"B"or better
O ter or author'vc agent Date