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CITY OF CUPERTINO
BUILDING DIVISIONPEI2NIIT .C:-4:bR: )I�1t�IATI01�i*.
BUILDING ADDRESS:
PERMIT NO.
20373 VIA PORTOFINO AKEENA SOLAR, INC nRi10021
OWNER'S NAME: PERMIT ISSUE DA'Z'E
M LUT14�p 16999 LGG GAIP96 BE 3SA CONTROL NO.
PHONE:
ARCHITE:CTIENGINEER: BUILDING PERMIT INFO
PHOTOVOLTAIC INST ON ROOF BLDG ELECT PLUMB MECH
o a LICENSED CONMACrOWS DECLARATION
m Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is
':'4)y in full force and effect /,/ 'q y �' .
rz�Z License Class L� �7 Lic.N- t3
F Dated h fO cL Contractoro' —2.�—
ARCHrrECrS DECLARATION
I understand my plans shall be used as public records
aV
u,y Licensed Professional
y OWNER-BUILDER DECLARATION
< I bereby affirm that 1 am exempt from the Contractor's License Law for the
in O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z m prior to its issuance,also requires the applicant far such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
F$ (commencing with Section 7000)of Division 3 of the Business and Profassions Code)or
.. 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 APN Number Occupancy Type
not more dtan Five hundred dollars($500).
❑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 or improves thereon,and who does such work himself or dlrough 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,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 contractors)licensed pursuant to the Contractor's
License Law.
01
am exempt under Sea ,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-insum for Workees 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 Worker's Compensation Insurance carrier and Policy number am:f� 4�
Cartier.-Al CJ`s Policy No.: ✓ ( ` V �J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 certify thet 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
Applican',:
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
.0
N
CONSTRUCTION LENDING AGENCY
+4-+ 1 hereby affirm that there is a construction lending agency for the performance of
: ' the work for which this permit is issued(Sec.3097,Civ.C.)
a A Lendcls Name
]rz Lender's Address
0 1 certify that 1 have read this application and state that the above information is '
'-" corrccL I agree to comply with all city and county ordinances and state laws relating to
VU building construction.and hereby authorize representatives of this city to enter upon the
y above-mentioned property for inspection purposes.
y LI.r (Wc)agree to save,indemnify and keep harmless the City or Cupertino against
y rA liabilities,judgments,costs and expenses which may in any way accrue against said City / / -
2
in consequence of the granting of this permit. "J
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _
SOURCBREGULATIO S.
Com_ Re-roofs
Signature of Applicant/Comramor 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 Safely
Code,Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs PNo
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 ha7.zxdous air contaminants as defined by the Bay Area Air Quality ManagemcnL all new materials for inspection.
District?
Dyes fiyNo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand tha if the building
dots not currently have a tenant,that it is my responsibility in nodry the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. Signature Of Applicant Date
&2y All roof coverings to be Class'``or better
Owner or authorized agent Date
obloo021
CITY OF CUPERTINO
SOLAR PANEL
CUPEI�TINO PERMIT APPLICATION FORM
AF'N# o Lf7 Date:
Building Address: b
Z,07373 V Pa -f f .i 0
Owner's Name: Phone#:
_T LL,4� er 660- 35 6 '3S Z �-
Contractor: Phone#:. 4 o S ' $S 5- q Contractor License#:
6 k ee" 'k Bah r Fax #: ? 310 2
Contact: (� Phone#: F f off_�S y _ y Cupertino Business License#:
o�tis IJvC�n�a�
Fax#:
Number of Panels/Units: Kilowatts (Commercial Only):
1 Z �,,7,e is
Job Description.
PV 1/7561(
Project Size: ExpressE& Standard ❑ Large ❑ Major❑
Residential Commercial ❑ Valuation(cost of project):
z�f1!3��f1�
Green Points:
1.2 KW—6 Points 2.4 KW— 12 Points ❑ 3.6 KW=18 Points El
FQ_uantity Fee ID Fee Description Fee Permit Type
Group
1SOLARPANL Commercial Solar Panel E SOLAR-COMM
1PHOTOVCOM Photovoltaic System E
Commercial
1BSEISMICO Seismic Commercial E
IELCPLNCK Plan Check Fee E
1SOLARRES Residential Solar Panel E SOLAR-RES
1PHOTOVRES Photovoltaic System E
Residential
1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B
Revised 6/16/08
Community Development
10300 Torre Avenue
Cupertino CA 95014
n Telephone(408) 777-3228
C1T1'OF Fax(408) 777-3333
CUPEI�TINO
Building Department
JOB ADDRESS: ' PERMIT #a?//Q// 0 O Z `
Z o 31.3 v;k Pario f; 10 d.,1
OWNER'S NAME: :r-r L v+1 ,tor PHONE #
GENERAL CONTRACTOR: A K ce a $e L a✓ FAX #
I am not using any subcontractors: ~_ D, 11-6 -Crg
Signature Date
Please check applicable subcontractors and complete the following information:
-gFSUBCONTRACTOR 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