03100211CITY OF CUPERTINO
BUILDING DIVISION P�lay
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BUILDING ADDRESS:
PERMIT NOO 3 10 0 2 11
20116 LAS ONDAS CT
OWNER'S NAME:
PERMIT ISSUE DATE
10/29/2003
PHONE:
SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION •
hereby Chaptcr 9
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Job Description
1 affirm that I am licensed under provisions of (commencing
with Seetlun_ 70JJ0)of Division 3 of the Busme. sand Professions Code, and in tcense is
in full forcac effect.,
SOLAR PHOTOVOLTAIC
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License Class
DateConzOictoilSP .ems
CONTRACTOR: SOLECTRI C ELECT.
ARCHITECI-SD ARATION `v�-�C•
—t-44—lielstandrnypIllans shall he usedaf public records
Licensed Professional '
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
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
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq: Ft. Floor Area Valu M_ 0 0 0
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
.
(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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
Occupancy Type
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
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will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractor's License Law does not apply to an owner of
properly 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, 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 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 Sec. , 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 aCertificate 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.
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❑ 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 arc,
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Cb¢Ze!If5 2M r-fi�rf:lG Policy No.
% CERTIFICATE OF EXEMPTION F M 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, I 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.
CONSTRUCTION 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
I certify that I have read this application and state that the above information is
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correct. I agree to comply with all city and county ordinances and slate laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
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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 Cily
.
in consequence of the granting of this permit. ''37
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued
by: Date
SOU
P� Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
defined by the Cupertino Municipal,Codc, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
roofs shall be inspected prior to any roofing material being Installed.
[:]YesAll
r/Ttt•7o
. If a roof is installed without first obtaining an inspection, I agree to remove
Will me applicant or metre building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
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❑ Yes Nu
.
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 V occupant of the
requiremems
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-Signature of Applicant Date
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All roof coverings to be Class "B" or better
Owner ulh agent Da