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080300460z 74 C 134 G UC r� L a Uz CITY OF CUPERTINO �[}V BUILDING DIVISION PERMIT ••.. BU1L.(ZII�,QDT6PPY WAY 11 ``jj REGRID POWER PERMIT No. 08030046 , OWNER'S NAME: PERMrr IS5UE DATE 1624 DELL AVE 04/02/2008 PHONE: SANITARY NO. CONTROL NO. (408)927-0811 ARCHITFCT/ENGINEEIL BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commertcing with Seetion7000)ofDivision3oftheBusinessanQpryfessio��andmylicenseis INSTL SOLAR(PV)SYSTEM ON RESDENTL ROOF in full force and effect License Gary Lic. A I/67_ Dale N / Contractor . i1M _ ARCHrrECI-S DECLAkkTION I understand my plans shall be used as public mcords _ Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703IZ, Business and Professions Code: Any city or county which requires a permit to construct. alter. improve. demolish, or repair any suuctum prior to is issuance, also requires the applicant for such permit to file a signed statement he is licensed to the of the Contractor's License Law 9 Sq. Ft. Floor Area Valuation that pursuant previsions (t]taptc Section 7000) Division 3 the Business Professions Code) $ 2 4 00 0 (commencing with of of and or that he is exempt therefrom and the basis for the alleged eseatption. Any violation of 3 6618026 Number Occupancy P Y Type Section 703L5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S-4M - ❑ I, as owner of the property, or my employees with wages as their sole compmudon, Required Inspections will do the work. and the structure is not intended or offered forsale (Sec. 7044. Business and Professions Code_ The Contractor's License Law does not apply to an owner of property who builds or improves 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.). ❑ L as owner of the property, am exclusively contracting with licensed contractors to concoct the project (Sec. 7044. Business and Professions Code:) The Contractor's L i- - c=w 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 Licenm Law. ❑ I am exempt under Sec B & P C for this resson 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 Workes Compem- radon, as provided for by Section 3700 of the Labor Code, for the performarheo 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 Compensation er and Policy number are^:? 2a I/� Carr;er. - S PolicyNo.: Ob / of l litres I C CATE OF EXEMPTION FROM WORKERS' COMPENSA7IONINSURANCE (This section reed not be completed if the permit is for onc hundred dollars ($100) or Ins.) 1 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 Worimrs' 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 Lahr Code, you must forthwith comply with such provisions or this permit shall be defected revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a consutictinn 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 " correct. 1 agree to comply with all city and county ordinances and sate laws relating a building construction, and hemby authorim repr=ntadvcs of this city to enter upon the above-mrntioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City iin consegpence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON -POINT Issued by:, '2 i�- SOURCE i�Gt1j..ATIONS. � '/A/ Re -roofs Type of Roof Signaulrd of Applicant/Contracar Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupaal store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 ❑Yes �No 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 devises which omit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes �Na 1 have mad the haxardhus materials requirements underChapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 undcmand that if she ¢wilding does not currently have a tenant, that it is my responsibility to notify the occupant of the rcqulmm hilt mA be rty(prior to a Certificate of Signature of Applicant Date w _cast /`f� e All roof coverings to be Class '%." or better . Owner ol authorizrdagent Da1e