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07040197- PUB O '> 0 E y N N ip U � y S 0 y a 3 a, y a y U 0 m u a- CL Q ' n z m u u yoca �o m v � v Lo CD Q U) M Q N - lJ � V O LC] 07 2l1 Cil a O � 0 0 o � O y cx o a CD w _ o .< oc (QS u A 0 m 0 D F N Ir O o W LCa W LLIO W fti F O A Mr� N W M co y W LLJ ~ O no H co El = U :5 a ,�. w LO ZD Lo a — %a, a 1 u O U) - N U) U Q O O Q U Idl i.� a� '.0• o D y y � 5^•,� XQ U I' y i0 llY C z u Idl I J d Idl, a a a a z a IL' O O O L Lo Oco i ICf l ,� J o J �,o Q w " a0 Qu> m CL J QQ til LL Uy Q (_S Q MLLJ C -4 �8 O O O 01 � z CL Or) L m 0 � o oQ o oC 0 4 CrWo o + o v N ry Q � ' : CL _ O U 1 1 O W 1 O M J � kh a� o cv o 0 o v' v Q Q r a fu a CL 0 - %� U > w !? o o s in a _ 3 7D 0 a1 N a1 -p O ip L.L_ y y o 0 0 - a� a' Q 5 `r `m U a - y y v 0 _ v U v E a O v V E w t. E y S a 'E y - E a) `m y a Or +o cn t) o u a� �° EL CL a 6 t) 6u� o Q u> U O cL o a- m 2 CITY OF CUPERTINO BUILDING DIVISION PE„ IT �� GC'17Et IVEUgtTI01�1 .. ;: PERMrr N0. BU'9t�RVATERFORD DR AKEENA SOLAR, INC 07040197 OWNER/'S NAME: PERMIT ISSUE DATE ADOOR BALASABRAMANIAN 605 UNIVERSITY AVE 05/10/2007 PHONE: (408) 867-0558 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEC14 O p LICENSED CONTRACTOR'S DECLARATION W p:. 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ROOF MOUNTED SOLAR MODULES a in full force and effect_ f1rJ 5 77 3 License Class L"fi 6 Lic.# �i p.,o Date 3/3) /c 9 Contractor A F-a 61 Z SrAelf n,•, ARCHITECTS DECLARATION u< i understand my plans shall he used as public records aV WO ti Licensed Professional y OWNER-BUILDER DECLARATION a I hereby affirm that I am exempt from the Contractors License Law for the p Ofollowing reason.(Section 71131.5,Business and Professions Cade:Any city or county 0 which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement z a that he is licensed pursuant to the provisions of the Contractor's Ucensc Law(Chapter 9 Sq.Ft. Floor Area Valuation t=.o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $19485 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of y�j�Number DCCu not more than five hundred dollars(5500). 3 6 61 7 0 2 9APN Occupancy Type ❑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 ofrered for sale(Sec.7044,Business 'Required Ins ections and Professions Code:The Contractor's License Law docs not apply to an owner ofP 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,Ne 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 Proressions Code:)The Contractor's Li- cense Law docs 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 Contractor's License Law. ❑I am exempt under See. ,B&P C ror this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty or perjury one of the following declarations: ❑1 have and will maintain a Certificate or Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance or 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 Workers Comppensatl1io'/n'Insurance car1rter and Policy number are; Carrier. 1 IM F7cl d Polity No.:4-6S-10 n_C AS — CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars(S100) or less.) 1 eeniry that in the performance of the work for which this permit is issued,1 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 Cenificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code•you must ,z forthwith comply with such provisions or this permit shall be deemed revoked. 0 CONSTRUCr10N LENDING AGENCY 1 hereby affirm that there is a construction(ending agency for the performance of > the work for which this permit is issued(See.3097•Civ.C.) Q Lender's Name z Lender's Address 0 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding conswction,and hereby authorize representatives of this city.to enter upon the Gra above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments.costs and expenses which may in any way accrue against said City Z in consequence of the granting or this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RF 2111-MCLNS Re-roofs -2, Signature of ApplicanVContractor Datc 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 Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes svo 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? ❑Yes NX. I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safely Code,Sections 25505,25533 and 25534.1 understand that i(the building does not currently hav a tenant.that it ism tbiIily to notify the occupant of the rcyuircmcnt;.w must b met prix Certificate of oee�upa/mcy. Signature of Applicant Date Owner or authorized agent Date All roof coverings to be Class "B"or better ' a � T CITY OF CUPER INO w SOLAR PANEL CITY OF CUPERTINO PERMIT APPLICATION FORM APN # � / ` Date::/� T a4/o Building Address:. -757L4a ee ac � IV Owner's Name: Phone #: Soor5 c- eniGn 40 9 ) �(o- S98 Contractor: Phone: 3 9 5 - 7? License #: ©S Contact: Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Job Description: R,0 0 M,0 Residential Commercial ❑ Cost of Projec 48 Qty. if Applicable Fee ID Fee Description Fee Group SOLARRES Residential Solar Permit BUILDING BUSLIC Business License BUILDING BENERGY Energy BUILDING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BSEISMICOM Seismic Commercial BUILDING -_} • Community Development < 10300 Torre Avenue ts. �r Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# �3 a X40( 1 0 ? 0Yb ��7 OWNER'S NAME: r PHONE # ( p - S GENERAL CONTRACTOR: FAX# I am not using any subcontractors- - -� 4 �d 7 Signature Date Please check applicable subcontractors and complete the following information 21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date