07110021 CITY OF CUPERTINO �����•�•������;��'�'��� ':
BUILDINC DIVISION PERMIT <
_; . :..
PERMIT NO.
au���txc a�oRess: AKEENA S JLAR , INC 0 7110 0 21 .
10162 BILICH PL
PERMIT LSSUE DATE
OWNER'S NAME: •
CHIN WAYNE F AND JOAN L 16005 LOS GATOS BLVD 12/03/2007
SANITARY NO. CONTROL NO.
PHO"E: (408) 867-0558
BUILDING PERMff INFO
.CH11EC['/ENGINEER: BI.DG ELECT PLUMB M6CH
� 0 � �
u p Q LICENSED CON'1RACfOR'S DECLARATION JOU DeSCT1PL1011
V I hcrcby �cm tha� � am �ic�nscd undcr provisions oCChaptcr 9(commcncinE INSTL 1 E ROOF MNTED SOLAR MODULES
�� aiih Sccdon 7000) of Division 3 of tho Busincss and Profcssions Codc, and my liccnsc is
�� y in full fo�ce an d e f fec� G "7 '7
� v� Z Licensc Clua ( ��— Lic. 8
r �� Datc I 7-/ �S /o "'� Conuactor
ARCHiTEC1'S DECLARA ON
t 1 undcrswnJ my plans shall be uscd u public records
;yU
; u. F' Lic:ensed Prufcssional
: � < OWNBR-HUILDER DECLARATION
y �
I t�crcby alTirtn U�at 1 am ucmpt Gum �he Conuaaors Liccnsc Law or c
� p O following reason. (Sccdon 7031.5, Business and Ptofcssians Catc: Any city or county
�,°, Pi which rcyuires a permit to consuuc4 altcr. improvc. demolish, ar �epair any suucturc
y' �' prior lo ils istuance, also requircs Ihe applicant far such permit to file a signed sta�emem ��, Ft. Floor Area Valuation
- Z< that he is liccnscd pursuan� to �hc provisions o f i h c Con u a c t o r' s L i c e n s c L a w ( Cha p�c� 9 �' 9 $ 1 7 2 3 9
Y F� (commcncing wi�h Scction 7000) of Division 3 nf IAc Businecs and Profcuiona Codc) or
y�� �}u� he is exempt tM.�efrom and Urc besis Cur the a1��8�d �ption. My violauon o[ Occupancy Type
Section 7031.3 by a�ry applicant for a pecmit sobjects �he aPP�ica"� �° a rivil penaity of 316 210 6�: �(� Number
not mme U u n f ive h u n dred dollan (5500�.
� I. u owner of tl�e property. ar my employces with wages u thcir solc compensaUon.
will do �he work and �he snuawe is not intended ororte�ed tor sale (Sec. �os4. Businesa Required Inspections
end Pcofessions Cade: The Conuactor's License Law docs not apply m an owner of
property who buitds or improves thereon, and wha das such wort himult or through hia
own employces, provided U�at such improvements are not imm�ded or otfered for sale. If,
however. the building w improvement is sold wi�hin one year aC completion. the owna-
builder will have the barde� of proving that he did mt build or improvc [or purpos� of
sa�.).
❑ I, as awner of the property, am exclusively conhacting wiih licenaed convutas w
constmct the penjea (Sec• 7044• Business and Professions Code:)'I2�e Coavutor's Li-
ccnse Law docs not spply �o an owner of propeny who builds or improves the�eon. �nd ,
who conuacts [or suc6 projecls w�th a convactor(s) licensed purswnt w �he Contractor's
L '�"� � , B k P C far this rcason
0 1 am eaeempt undu See.
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby afiirm under penalty of pery'ury one o[ ihe follawing declustions:
Q 1 hsve and will mainuin a CeniGcaee of Consent to self-imure far Workcls Compen-
�cion, as providcd far by Section 3700 of the i,bor Code. [or �he performancc ot �t�e
�rk (or which this pertnit is issucd.
❑ f have and wiU msintain Workcr's Campensation Insunna, as iequired by Scction , •
3700 oC �Ae Labor Codc. fw ihc performmce of the work for which �his permit ia issued.
My Workers Compensation Insurancc cartice snd Poliry number ue: �
Cartier: i�..-�(� r i n!� Poliry No.: � Z �
�ERTiFICATE OF EXEMPCION FROM WORKERS' .
COMPENSATION INSURANCE
(ihiy section need not bc canple�ul if ihe permit is for onc hundred dollus (5100) .
ar Icss.)
I cenify �hat in thc performance of �hc work for which �his permit is istucd. I shall not
e:nploy any person in any manncr so u w bcrnmc subject to �he Workers' Compensadon
Laws of Califomia. Datc
Applicant
NOTICE TO APPE.ICANT: !f, aMr making ihis Ccnifica�c of ExcmpGon, you shauld
become subjcct w ihc Worker's Compcnsation provisions of �he Lalwr Codc. you muu
� Q fonhwith comply wi�h such provisions or thia pecmit shall6c dccmcd awokcd.
� � CONSTRUCI'!ON LENDING AGENCY
E„i ,.•, � hcrcby a[tirm that thcro is a consuucdon icnding agcncy far thc performancc ot
a� thc work for which this permit is issued (Scc. 3097. Civ. C.) •
W Q Lendcr's Nvnc
� z C.ender's Address
V � � anifY ihat I have resd this applicuion and sntc ihat thc abow informatiun is
w � cortcc� I agree w compty wiU� a!I eiry and county ortiinences and suu laas celating w
� U building consuucGon, and heieby auchoria �cprcxntaGvcs of ihis ciiy w cnter upnn ihc
� W allove-menuo�d pmpeny for inspection purposes.
a (wr�) sg�ce to save, indcmnify and kecp hacmless � Ciry o[ Cupcnino against
� y liabilitiu, judgmenta, costs and expenses which may in any way ucruc against said City �/� .�
V� in consequencc oC thc g�andng of this permiG Date �
►� APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
pii� Aw ww �.� / ,�. .. �,�/� � �o Re-roofs �"�
Signa� fApplian�Conuactor Da � 'I' of F :OOf
HAZARDOUS MATERIALS DISCLOSURE YP
�Il the applicant or futurc building acupant sarc or handlc ha•rardous mamrial
as dcfincd by Uu Cupenino Municipal Code. Chaptcr 9.12. and chc Hca1W and Safety
c«k Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ y� C�to
T If a roof is installed without first obtaining an inspection, I agree to remove
Will �hc applicant or fuwrc building occupant usc cquipmcnt or dcvices which
emi� ha air contaminan�s dcfincd by the EaY Area Air Qusliry Managcment all newr r, �aterials for inspection.
Oistrict?
�ya No
I havc rcad we hvardcws mamrials requiremcn�s undcr Chap�cr 6.95 of ihe CaliCor-
nia Hcal�h & Safcty Cadc, S�xiiau 23505, 25533 and 25534.1 undcrs�and thatif ihe 6uilding
docs not curtcntly havc a tcnan4 �at it ia my rcsponsibiliry w noufy thc occupant nf ihe „" Date
requiremcn�s which must be mel 'or w issuancc o[ a Cerufica�c af Occupanry. S Igngturf : Of App1lCaRt
Z All roof coverings to be Class B or better
O r or authorized agcm ��