03090149CITY OF CUPERTINO
BUILDING DIVISION PER1Vii��lYd�
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US
BUILDING ADDRESS:
MC SOLAR ENGINEERING
PERMIT "003090149
OWNER'SNAME:
1168 ASTER AVE
PERMIT ISSUE DATE
PHONE:
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(408) 261-1211
SANITARY NO. CONTROL NO.
ARCHITECT -/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
hereby Chapter 9
Job Description
I affirm that 1 am licensed under provisions of (commencing
with Seed ) of Division 3 of the Business Professions Code, and my license is
Lfullrr ndcrfect. v
License Lic. N ai (G
PHOTOVOLTAIC SYSTEM - -
Datc Conti L
DE ATION
ARCHITECTS
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
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following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$i nnon
prior to its issuance, also requires the applicant forsuch permit to rile a signed statement
Sq. Ft. Floor Area
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
Valuation .
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
37513016.00
- — --- -ATN Number
Occupancy
ane. Type
P Y--
Section 7031.5 by_ applicant for a permit subjects the applicant to a civil penally of
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not more than rive hundred dollars ($500).
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❑ 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 offered for sale (Sec. 7044, Business
304 — ROUGH
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and Professions Code: The Contractor's License Law docs not apply to an owner of
builds improves does himself his
�ns
501 - FINAL ELECTRI AL ENERGY
property who or thereon, and who such work or through
own employees, provided that such improvements are not intended or offered for sale. If,
505 — FINAL ELECTRICAL
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 the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
,
cense Law docs not apply to an owner of property who builds or improves thereon, and,
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who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this mason
Owner Date
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally 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
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
3700 the Labor Code, for the performance of the work for which this permit is issued.
My
tcy No.: Ij4;r '0k_O J^
( CERTIFICATE OF EXEM ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify 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 Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of, the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCI-ION LENDING AGENCY
I 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.)
Lender's Name
Lender's Address
1 certify that I have read this application and stale that the above information is
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correct. I agree to comply with all city and county ordinances and state laws, relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(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
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR E REGU IONS.
Re -roofs
Type of Roof
Date
HAZARDOUS MATERIALS DISCLOSURE
ill the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal,Codc, Chapter 9.12, and the Health and Safety
Code, Section X.25532(a)?
[]Yes
❑
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District? /�
E3 Yes 1L�Nu
1 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
does not currently have a tenant, that it is my responsibility to notify the occupant of the
re irements which must et prior to issuance ora Certificate of Occupant .
Signature of Applicant Date
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All roof coverings to be Class "B" or better
-owner
or out zcacot Da