09100169CITY OF CUPERTINO
CO1VTRe ,.,, =nR4IIVFU;l2
BUILDING DIVISION PERMIT
C & D FREITAS CONSTRUCTIO
BUILDINGADDRESS:
'PMMMNO-06020162
10110 LOCKWOOD DR
ER'S NAME:
PERMITISUPDATE
23610 MORREL CUT-OFF RD
03/07/2006
PRONE:
SANITARY NO. CONTROL NO.
(408)353-1228
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
LICENSED CONIRACTOWS DECLARATION
Job Description
1 lately, from Net I am licensed under proviaiau of Coal., 9 (camancing
iwith Snelian .fallforce and tvtaian3.fOW Business and Prolcssiuns Cadc.and mylicereia
REVISION -ATTIC STORAGE (REVISE GARAGE CLG. )
Class Lk.X
NO NEW PERMIT ISSUED/ORIG 05090008
Dow
Dam C'S
DECLARATION ARCHITECT'S DECLARATION
1 understand my plans shall W used a public records
Licensed PmfcuimN
OWNER -BUILDER DECLARATION
I hcrehy affirm that I am exempt from den Co i nctofs License Law for the
following meson. (Section 70313. Business and Profession, Code: Any city or county
which acquires a permit to construct. Alter, Impmm, demolish, or repair any suuclum
poor um its issuance, Also, requires the applicant for each permiuo file a signed statement
Net W is licensed pursuant to the provisions of the Contncmr's Licenm Law (Chapter 9
Sq. Ft. Floor Area
aluation
(commencing with Section 70W) of Division 3 of the Business and Prefessions Cork) or
Nal W h exempt themfmm and do, bub for dm Alleged ca=pfon. Any vi.l.dan of
pN N�I�Iber
4
Eupancy Type
Section 7031.5 by any applicant for a permit subjectithe applicant m a civil penalty of
not mare than five hundred dollars(S5W).
3 214 5 0 0
21
0 1, as owner of Ne property, or my employees with wages As decosole compensation.
e
Required Inspections
will do Newark, and deswmure is not intended oroRered forsalc (Sec. 7W, Business
and Pmfaulans Code: The ConuecmYs License Law does not apply to an owner of
q p
property who builds or improves thereon, and who doer such work himaelf or through his
own employees, provided Nal such improvements am not Intended oraffmcd forsalc. If.
however, the building or improvement is sold within on year ofcompletion. the owner.
builder will ban do, burden of proving drat W did not Wild or improve for purpose of
sate.).
0 I, as Manor of the Property, am exclusively contracting with licensed contractors to
construct the project (Sec. 70", Business and Professions Code:) The Comm c an'. U.
cense law does not apply to an Owner olpropeny.who Wilds or improv thereon, and,
who contra for such projects with a contractor(s) licensed pursuant in the Contractoes
License Law.
❑ I ore exempt under See. . B & P C for this mason
Data
Or WORKER'S COMPENSATION DECLARATION
I hereby afrnm under penalty of perjury one of the following deelmooni :
0 I have ono will maintain a CCni37M of Cement fm Workef
of
nce the
soon, provided far by Section 37th of IW labor Cade. for time penonnartee of six
Code.
work for which this permit is issued.
r
0 1 have and will maintain Weake's Compevadon luurance. as acquired by Section
37th of to IaWr Code, fm the performance of the work for which this permit is Issue.
My Worker's Compensation Insunntt carrier end Polity number am:
'
Carrier: Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if IW permit is forone hundred dollars ($]W)
to less.)
1 cenify Not in the parfurmanee of the work far which this permit is issued. l shell not
employ any Factor, In any meaner as as On become subject in the Workers' CompenadM
Laws of California. Data
'
Applicant
NOTICE TO APPLICANT: If, after making this Ccnifielde of Exemption, you should
become subjeet to the Woher's Compensation provisions of the Labor Code, you main
fonowi th comply with such provisions M Nis permit shall W deemed mvoked.
I
CONSTRUCTION LENDING AGENCY
I homby affirm Net them is a construction lending agency for performance of
' the work for which this permit Is issued (Sec. 3097, Civ. C.)
'
Lender's Name
Landefa Address
I eenify that I have mad Nia application and sum Nat on, W. infom .om is
a correct. 1 agree m comply with all city no county ordinances and sate laws nelning in
building construction, and hereby Guthurim represenutim of this city in tour upon site
ahava-mentioned pmpeny for inspection pugmas
(We) agree to an, indemnify ad keep harmless the City of Cupertino against
liabilities, judgments. coast and expenses which may in any way ettmc against aid City
in consequence of the &noon&of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of ApplicaL Doc
HAZARDODO US MATERIALS DISCLOSURE
HAZA
ant d
WIII the applicant or futureno occupant or handle hazardous materiel
u defined by the Cupertino Municipal Cde. Chapter 9.11, and the Health and Safety
'
de. Se 25s3xaY!
All roofs shall be inspected prior to any roofing material being installed.
y. ON.
❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building =open, use equipment or devices which
cmll hanrdnus air co ostrom nu As defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
O Yce ON.
I have mo the handout materials requimmenu under Chapter 6.95 of the Califon
nia Hculth & SafctyCoM, Secdons 25503,15533 and 25534.1 understood Nat if the building
docs not currently ban a =nam, thAl it is my responsibility m notify the Occupant of this
mgalmmcnav which most the mel prior to issuance of a Cceifi=te of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or ewhorimd agent Data
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10110 LOCKWOOD DR
CONTRACTOR: AKEENA SOLAR, INC
PERMIT NO: 09100169
OWNER'S NAME:
16005 LOS GATOS BLVD
DATE ISSUED: 11/20/2009
OWNER'S PHONE:
LOS GATOS, CA 95032
PHONE NO: (408)867-0558
❑ LICENSED CONTRACTOR'S DECLARATION
F F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 4 C `('J Lic. # �"C�5 '77 �
r,
�
)
Contractor ;"j �({� So(- ✓ Date
RESIDENTIAL
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ROOF MOUNTED SOLAR ARRAY,28 PANELS/UNITS,4.9
(commencing with Section 7000) of Division 3 of the Business & Professions
KILOWATTS
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: 530132
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 34214115.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued '�'�� Date:
Signature Date 2 D
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
O Lc thorized agent:
become subject to the Worker's Compensation provisions of the Labor Code, I must
? Date: U
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date