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O IL u5 _a lj Ll Lo L cY a- U ' U LU L1 ' — CITY OF CUPERTINO BUILDING DIVISION PERIVIITJlfl � � � * BUILDING ADDRESS: PERMIT NO. 20711 SCOFIEL12 DR REC SOLAR INC. OWNER'S NAME: PERMIT ISUE DATE ANKL;E PHON : CONTROL NO. (888) 657-6527 ARCHITHCTIENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH 0 0 a 0 u O o LICENSED CONTRACTOR'S DECLARATION Job Description u 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P with Section 7000)of Division 3 of the Business and Professions Code,and my license is � y in full force SOLAR PFJ SYSTEM FLUSH MOUNTED ON ROOF 3 ? License lass C/ Lie•R y o Dam — Contractor .u-1I CHrTECI'S kRATM w< 1 understand my plans shall be used as public records a 4 O y Licensed Professional n OWNER6BUILDER DECLARATION `X I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county ,,off which requires a permit to construct,alter,improve,demolish,or repair any structure ' y Z� prior to its issuance,also requires the applicant far such permit to file a signed statement ES G that he is licensed.pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft,Floor Area • Valuation X F$ (commencing with Section 7000)of Division 3 of(he Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of $49000 Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of C APN Number Occupancy not mom than five hundred dollars(5500). P Y Type Q Las ownerof the property,ar my cmployw with wages as their sole compensation, 35909014 . 00 willdo the work and the structure is not intended or offered forsale(Sec.7044,Business and Professions Code:The Contractors License Law does not apply m an owner of Required Inspections 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,die owner- builder will have the burden of proving that W 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 Contractors Li- cense Law does not apply to an owner of property who builds or improves uhemon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. Q I am exempt under Sec B&P C for this reason Owner Date WORKER'S 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 Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the wart for which this permit is issued, Q I have and will maintain Workcr`s Compensation Insurance,as required by Section 3700 of the Labor Coded ,for the performance of the work for which this permit is issue ' My Wor s C mpens tion Insurance carie and Policy Cartier. t � Policy No.: Y C IFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) or Icss) 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,alter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the tabor Code,you must �`L forthwith comply with such provisions or this permit shall be deemed revoked. Z O cONsmucnON LENDING AGENCY 1 hereby affirm that them is a construction lending agency for the performance of LL';> the work for which this permit is issued(Sec 3097,Civ,C.) aA Lentices Name — 2 Lenders Address U Q 1 certify that 1 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 Q V building construction,and hereby authorize representatives of this city to enter upon the aandve-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against hey � liabilities,judgmcros,costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit ^" APPLICANT UNDERSTANDS ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER ATI _ 7 —{vJ�� Re-roofs Si ure ofli contractor am AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the plicant or future building occupant store or handle haymilous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code. Sect'on 25532(a)7 All roofs shall be inspected prior to any-roofing material being installed. Yes ,©No 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 Area Air Quality Management all new materials for inspection. District? Q Yes phi__/ I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Secuons 25505,25533 and 25534.1 understand that if the building does not currently have MnanL that h is 'bility to notify the occupant of the requirements which t be me f a Certificate of Occupancy. Signature of Applicant Date Owner uthoriz agent Dam g assAll roof coverings to be Classor better el CITY OF CUPERTINO SOLAR PANEL CUPEkTINO PERMIT APPLICATION FORM 6a l� APN# Date: uilding Address: Owner's Name: one#: 40aS -336 C ntractor: Phone#: 'Contractor License#: C �ad SQL. Fax #: L1 -2996 � g Contact: 1�p Phone#: / i6 Cupertino Business License#: Fax #: 1O4 `3Qg" Number of Panels/Units: Kilowatts (Commercial Only): Job Description: Project Size: Express Standard. Large Major ❑ Residential Commercial ❑ Valuation(cost of project): Green Points: 1.2 KW—6 Points ❑ 2.4 KW- 12 Points 3.6 KW— 18 Points 0 Quantity Fee ID Fee Description Fee Permit Type —Group 1SOLARPANL Commercial Solar Panel E SOLAR-COMM 1PHOTOVCOM Photovoltaic System E Commercial 1BSEISMICO Seismic Commercial E 1ELCPLNCK Plan Check Fee E 1 SOLARRES Residential Solar Panel E SOLAR-RES 1PHOTOVRES Photovoltaic System E Residential 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B Rdvised 6/16/08