07040248 CITY OF CUPERTINO
BUILDING DIVISION PERMIT V� ►VT11� � "
PERMIT NO.
BUILD��i�f �ESMCCLELLAN ROAD AKEENA SOLAR, INC 07040248
''ER'SUNAME: PERMIT ISSUE DATE
aT JUDE CHURCH 605 UNIVERSITY AVE 05/10/2007
PHONE: SANITARY NO. CONTROL NO.
(408) 867-0558
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p a LICENSED CONTRACTOR'S DECLARATION
%V P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
.z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL SOLAR (PV) SYSTEM ON ROOF
y in full force and effect /' Q S 7 3
? License Class ` Lic.S
O dI. �eY
f Date ARCHITECTS DECLARA ION
2W 1 understand my plans shall be used as public records
)yU
Win Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city or county
`<m ff which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area $42000 Valuation
u1- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
u;§
§ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of p umber Occupancy Type
not more than five hundred dollars($500). 3592
0 0 0 2�'. (
❑I,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 fired Ins ections
and Professions Code:The Contractor's License Law dols not apply w an owner of fl P
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 U.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a comr-Actor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
it Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of Ux
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 Coluon Insurance carrier and Policy number are: n
Carrier. S �n 11 Policy No. b S-000a l y"!S
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 Workcrs'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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
E+►�-� I hereby affirm that there is a construction lending agency for the performance of
fl; the work for which this permit is issued(See.3097,Civ.C.)
Wfs,Q Lender's Name
Z Lender's Address
f J 0 I certify that I have read this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
0 Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned properly for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
tirA liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit
APPLICANT UNDERS L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG
~—� W-1 Re-roofs
Signature of Applican on r Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
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
'e,Section 25532(a)? All roofs E hall be inspected prior to any roofing material being installed.
❑Yes GNVu
Will the applicant or future building occupant use equipment or devices which If a roof is 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 gNu
I 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 utc building
does not currently have a tenant,that it its my responsibility to notify the occupant of the
requiremust be met prior wi 'fr:ateofOccupancy: Signature of Applicant Date
Owner orauthorizcdagcnt Da,/ All roof coverings to be Class"B"or better