07040197CITY OF CUPERTINO
PERMIT
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BUILDING DIVISION
111LaTS'NMTERFORD DR
AKEENA SOLAR, INC
PERMrr NO.
07040197
r 'SR'S NAME:
PERMIT ISSUE DATE
ADOOR BALASABRAMANIAN
605 UNIVERSITY AVE
05/10/2007
PHONE:
SANITARY NO. CONTROL NO.
(408)867-0558
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
ROOF MC UNTED SOLAR MODULES
in full force and effect IrJ S % %
License Class Lia N ,
Date Contractor Lt dol1a S416.1'- inP.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter. improve, demolish, or repair any structure
r r q, Ft. Floor Area
Valuation
! prior to its issuance. also requires the applicant for such permit to rile a signed statement
License Law 9
that he is licensed pursuant to the provisions of the Contractor's (Chapter
$19485
(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
3661702 9?'PN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
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 Comracmes 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 Conu-actoes
License Law.
Q [ 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:
❑ 1 have 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
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 nation Insurance carper and Policy number are: p
ccom
Carrier. I rr/1'% 8 Policy No.: ,` 6 S - 22 n C (AFD
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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION 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.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize 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
n liabilities, judgments.costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date —S'
SOURCE REG LA QN_ ,_
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Re -roofs
Type of R oof
Signature of Applicant/Contractor Dare
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
C,Section 25532(a)?
All roofs :;hall be inspected prior to any roofing material being installed.
❑ Yes Wu
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 contaminants as dcrincd by the Bay Arca Air Quality Management
all new materials for inspection.
District?
QYes C3�1u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health &Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently ha tenant, that ft ;s m ability to notify the occupant of the
rcyu;rcmen ,must met prio a� su f a Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorized agent Date