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03080031CITY OF CUPERTINO BUILDING DIVISION PERMIT INFORI 4ATI . BUILDING ADDRESS: PERMIT NO 03080031 OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. _ CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH QO O LICENSED CONTRACTOR'S DECLARATION I hereby Chapter 9 Job Description UI affirm that 1 am licensed under provisions of (commencing Z w with Section 70(10) of Division 3 Df the Business and Pe sions Code, and my license is in full force and effect. e IU t' %a� PHOTOVOLTPIC SOLAR SYSTEMS (2.5 KW) j n ? License CI Lic. tt _ :Fo Date Contractor W 47 f CONTRACTOR: J & J OWENS ELECTRIC INC. a ARCHITECT'S DECLARA ON a I understand my plans shall be used as public records �yU 4 O N Licensed Professional n N a OWNER -BUILDER DECLARATION �a i 1 hereby affirm that I am exempt from the Contractor's License Law for the o0 following reason. (Section 7031.5, Business and Professions Code: Any city or county $ li 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 rile a signed statement .. 4 that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (yn 0 0 0 Sq. Ft. loos Area Valu $tio0 � o x Y F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or y 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 x7 �,.,�i 3 �1Ni�1W rYJP.rO 0 Occupancy Type P Y Y P not more than 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 License gInspections and Professions Code: The Contractor's Law docs not apply to an owner of 101 — FOUNDATION 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. 102 — PIERS 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 103 — UFER - sale.)' 104 — REBAR ❑ I, as owner of the properly, am exclusively contracting with licensed contractors to 10 5 ANCHOR BOLTS 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 10 6 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 202 — UNDERFLOOR PLUMBING ❑ I am exempt under Sec. ,B& P C for this reason 203 — UNDERFLOOR MECHANICAL Owner Date 204 — UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION 1 hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑ I have and will maintain a Certificate of Consent to self-insum for Worker's Compen. sation, as provided for by Section 3700 of the labor Code, for the performance of the 302 — TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ 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. 304 — ROUGH ELECTRICAL My Workers compensation Insurance carrier and Policy number are: 3 05 — FRAME Carrier: Policy No.: 306 — HOEDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 — INSULATION (This section need notbe completed ifthe permit is for one hundred dollars ($100) 308 — SHEETROCK or less.) 309 — EXTERIOR LATH I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any man etas h1 ome subject to the Workers' Compensation 310 — INTERIOR LATH Laws ofCaliforni 311 — SCRATCH COAT Applicant NOTICE TOA L . after making thistCcnificaw of Exemption, you should 313 — ROOF NAIL become subject to th orke, i s Compensation provisions of the labor Code, you must Z forthwith comply with such provisions or this permit shall be deemed revoked. 501 — F I NAL ELECTRICAL ENERGY o 502 — F I NAL PLUMBING ENERGY Z CONSTRUCTION LENDING AGENCY [- VI 1 hereby affirm that there is a construction lending agency for the performance of 503 — F I NAL MECHANICAL ENERGY a> the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name W Q 504 — FINAL BUILDING ENERGY Lender's Address � z 505 — FINAL ELECTRICAL U C) I certify that 1 have read this application and state that the above information is 506 — GAS TEST V. — correct. I agree to comply with all city and county ordinances and state laws relating to � � building construction, and hereby authorise representatives of this city to enter upon the C) Uabove-mentioned FIN PLUMB I G property for inspection purposes. O 8 F I L C>w (We) agree to save, indemnify and keep harmless the City of Cupertino against HVi liabilities, judgments, costs and expenses which may in any way accrue against said City 5 '^ 2 U Z in consequence of the granting of this permit. r APPLICANT U D RSTA D AND WILL COMPLY I,TH L ON -POINT Issued by: 5 CING Date Date AZARDOUSMATERIALS DISC L SURE Type of Roof Wil a app cant or future building occupanlstore or handle hazardous material as defined the Cu 'no Municipal Code, Chapter 9.12: and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected to any roofing material being installed. ❑Yrs u prior If a roof is installed without first obtaining an inspection, I agree to remove Will the aRpllicant or future building occupant use equipment or devices which emit hazardous air comet s mants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes _ 1/////////�� I have read the ha72rdous materials requirements under Chap ter 6.95 of the CaIifor- 4A 7 6 niaHealLit & Safety Code, Sections 25505,25533and 25534.1understand that ifthe budding docs Itcu c lly ha v a tenant, that it is my responsibility noufy th pant of the require ,� Date