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CITY OF CUPERTINO �
DIVISION PERNII'T�i�l�CJ1��li
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BUILDING
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BUILDING ADDRESS:
861 COTTONWOOD DR
AKEENA SOLAR, INC
PERMrr NO.
08010070
:
SANITARY NO. CONTROL NO.
(408)867-0558
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I an licensed under provisions of Chapter 9 (commencing
with Section 70D0)ofDivisfon3oftheBusiness and ProfemionaCode,andm liccnscis
INSTL 14 PV SOLAR MODULES TO RES ROOF
in full force and effect -�
License Clan I.k. I
'
Dam Contractor
ARCHrI'ECIS DEC ATION
I understand my plans shall be used as public records
Uccnsed Professional
OWNER -BUILDER DBCL ARA71ON
I hereby affirm that i am exempt from the Contractors 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 structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
mat he is licensed pursuant to the provisions of the Contractors Uccnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$18 5 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
,ep Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of
not more than five hundred dollars (SS00).
36917036 : t7
❑ L as owner of the property. or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec.7044, Business
.rid Professions code: The Contractor: Ucense Law does not apply to an owner of
property who builds or improves ihercon, 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.).
❑ L as owner of the property, am exclusively conuacling with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U-
ccnse Law does not apply to an owner of property who builds or improves thereon, and,
who contras for such projects with a contractor(s) licensed pursuant to the Convectors
License Law.
C7 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 a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code. for the performance of the
work for which Otis permit is issued
I have and will maintain Workers 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 numb r are:
Cartier. .S i se. Ft,/I d PolicyNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis section need not be completed lithe permit Is fa one hundred dollars ($100)
or less.)
I certify that In the performance of me 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, alter making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Codc, you must
forthwith comply with such provisions or this pemil shall be deemed revoked.
I
' CONSTRUCr10N LENDING AGENCY
I hereby affirm that there is a csnst uetirm lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
j 1 ratify that I have read this application and state that the above information is
' correct I agree to comply with all city and county ordinances and state laws relating to
' building construction, and hereby authorire mpresentaWes of this city to eater upon the
above-mcndoncd property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
i liabilities judgments, costs and expense 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
applicant or future Mdldmg occupant store or handle hrvardous material
as defused by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Codc, Section 25332(a)?
All roofs shall be inspected prior to any roofing material being installed.
El Yes fJ(No
r
If a roof is installed without first obtaining an inspection, I agree to remove
WBi the applicant or future building occupant use equipment or devices which
emit haiardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
DYes
_10No
I have mad 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 leant that It is my responsibility to notify the Occupant of the
requiremens which must be met prior to issuance of a Cenifiate of Occupancy.
Signature of Applicant Date
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