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08060107- PUB 0 L[ LL '7 O N d) U N N C U a- ki) y S y y N C a 3 � y 4) Cl O m U LL � S} II-5 Q 2 U u O G1 Z Q� F— CD 0 LO 3 ., r4 OJ W U 0 U OD a a — Q L9 F C3 a 7. 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CONTROL NO. (408) 927-0811 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i O C LICENSED CONTRACTOR'S DECLARATION ,to U G I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description .Zwith Section 7000)of Division3oftheBusinessandProfessionsC,-ode,andmylicenseis ADD/INSTL PV(SOLRELCTRC) SYS ON RESDNTL ROOF t 7 1 y in full force and effect3 U 1 Z License Cl s Lic.p — ' F,p Date Contractor a ARCHITECTS DECLAR ION mU I understand my plans shall be used as public records ,a y Licensed Professional y OWNER-BUILDER DECLARATION j a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ❑O following reason.(Section 703 1.5,Business and Professions Code:Any city or county e which requires a permit to convect,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation ut- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $44056 ,, .- 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 penalty of Number Occupancy Type not more than five hundred dollars(5500). 36653020 W ❑1,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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds orimproves thereon,and who does such work himself or through his own employers,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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- . cense Law does 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. E]I am exempt under Sec .B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ' ❑I have and will maintain a Certificate of Consent to self-insure far Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of 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 Wor s Compensation Insurance carrier and Policy number are: Cartier. � �nc- Policy No.:C,;w CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars(5100) or lets) I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any mannerso as to become subject to the Workers'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 _Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constroctinn lending agency for the performance of Si > the work for which this permit is issued(Sec.3097,Civ.C.) - 4 QLender's Name 2. z lender's Address ' J 1 certify that I have read this application and state that the above information is HcorccL I agree to comply with all city and county ordinances and state laws relating to U building convection,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against f!I liabilities,judgments,costs and expenses which may in any way accrue against said City J Z in consequence of the granting of this permit. ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z Lt SO E REGULATIONS. � Re-roofs S�nati rr of ApplicanUContmctor 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 Code,Section 25532(a)? 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? ❑Yes IQ,No 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 the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be in or to issuance of a Certificate of Occap arty. Signature Of Applicant Date All roof coverings to be Class or better Own&or authorized agent Date � g /"f CITY OF CUPERTINO it- n' 1 SOLAR PANEL OF CUPERTINO PERMIT APPLICATION FORM APN# 6,� � v�O, �� Date: b Building Address: 1D a Ls-rsmofez CT. Owner's Name: Phone#: f1RR (7REEVE yo8 �al�- 41669 Contractor: �. �OW er Phone#: YD?-37o-36C)0 Contractor License#: Fax #: ((08 V7 7 Contact: Phone#:9D8- '670 -3660 Cupertino Business License#: x�os 11flRfl �f�vfi�iV Fax #:yoF- 704- 54 Number of Panels/Units: Kilowatts (Commercial Only): • 33 Job Description: 1N 5741-1. PV (Soe_49 LL C_ O r0c) SY57-,Er4 ON RE S1DEti7iF1 t 2voF Residential ,� Commercial ❑ Valuation (cost of project): Green Points: 1.2 KW—6 Points ❑ 2.4 KW— 12 Points ❑ 3.6 KW— 18 Points , Quantity Fee ID Fee Description Fee Permit Type Group 1.SOLARPANL Commercial Solar Panel E SOLAR-COMM 1PHOTOVCOM Photovoltaic System E Commercial 1BSEISMICO Seismic Commercial E 1 ELCPLNCK 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 Community Development 10300 Torre Avenue 1 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: PERMIT:# 1 69 Gv.ES7 SH09 t GT• QJ6�d(Cr7 OWNER'SNAME: fzEENt: PHONE # yo 8 - GENERAL CONTRACTOR: Qe ,., r FAX # (.(O e-- 90 Vk I am not using any subcontractors: i'� cacti 6 D Signature Date PIease check applicable subcontractors and complete the following information: 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 O6A0 e Owner/C actor Signature Date