08090080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA.CTQRINF,ORMATION
BUTTOJNy�3 DBBFSS: PERMIT NO.
1VS�b AVENIDA LN HORIZON ENERGY SYSTEMS 08090080
'S NAME: PERMIT ISSUE DATE
LEE & JULIE MOUCTON P 0 BOX 320612 09/23/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 395-9060
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
0 0 0 0
IoijLICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hm d
cmbY affirm 1 are lisvcd under provisions of CluPur 9(commencing P
t.l riNSection 7")ofDivism.3ofNeBumeess"PmfessionsCode."myliaeseu PV(SOLAR ELECTRIC)GRID-TIE SYSTEM 4 . 9KW
n o, in full forte and ef{e
j ? License Class
_L Lk.a
n t- Dam s ARCNR A DELL RATION Y S/ t��" S
U I undrsan
ed my plana ahu all x need public mcnada
6
a Licensed Professional
OWNER-BUILDER DECLARATION
t� i hereby aRrm
that I am exempt from dm Contractors License law for the
O O following maw..(Secure 7ML%Business and Profession Code:Any city or county
5s$ which require a permit w cnnatrud alkq improv,demolish,Or repair any sruch re
iy prior to its iuwruc.also requires Bre applicant forach permit to file a signed atskmpnt
< That he it licensed pursuant rode provisions of the Contractor's Laren Law(chapter 9 Sq.Ft.Floor Area Valuation
i� (commencing withSection 700D)Of Division 3 of Bre Business and Prufeui...Code)., $44092 -
e R$R this he is except therefrom and the bun for the alleged exmptim.Any violation of
Section 7031.5 by any appikam fora Permit wbjccu the appl'mans w a civil penalty of Number Occupancy not mom than five hundred dollars($M. 34245037 ,pp 64 Pcent Y T YPe
�I,u owner of IW proprsty,a mY moplvycu with wage u the'v wk smmpenudon,
avid do Nsumns and We h.Com unotkxndcd Law does
net a(Sec.in to Business
and property
an Code:The Contrumrs ndwho law does not apply 1f an owner is Required Inspections
propertywho Wilda«dcd ftves Ihimnandwhodoesaum wart himsclforWough his
taw aver.the
Nat such improvements tie ne year ofc ocaQerW(orale r-
hildsor the have
Ban
uimprowmmsuhat wiminonegildorcompletion,meownm-
builder HO Nv IW human of proving that k did Out Wild or improve for purpose of
cele.).
El 1,a owxr of the property..m uelusivly contracting vim licensed concremon to
musmtt de project(See.7003.Buinu s and Profusion Cede:)The Cmbanots V-
cense law does not apply to a.owner of propeny who Wilds or improves there n.and
who contracts for such projects with a camrxwr(s)licensed pursue,to the Con=toes
11 nee taw.
w ucmpt rode See .08 PCfm Nis mown '
r Dat
WORKERS COMPENSATION DECLARATION
1 bereby affirm under penalty of perjury ma:of One folkwiny deelaadome
I lav and will maintain a Ccnifiom ofConsent a self loam fm Waiter.Compen-
ution,u Provided for by Section 3700 of the Labor Code,for the Performance of Ne
wort for.Eieh this permit is issued.
El 1 haw and will maintain Worker's Compenasion Insurance,as Iryuired by Section
3700 offt LaEOr Code,for the Performance of me wort for which this permit Is issued
My WorteYss Coommpewuon huuo nce artier and Policy number us:
Cartier. J(d.4, F.fr PolicyNo.: -!,11)f'7 f 2 '3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Oris suction need rot x completed if the permit is fmone houseddollan(sloo)
or less.)
T certify that in the performance of the wort for which this Permit is Wood.I shall not
employ any person in my mamcrm as In become subject to the Workers''Compmeauiw
laws of Califomin.Dam
Applicant
NOTICE TO APPLICANT:If.afar mating this CeNrtue of Eaemplem,you should
become subject in the W.rters Compensation prevision a the labor Code,you most
.J z forthwith comply with such provismS Or NU Permit shall he decreed revtcd.
zCONSIRUCnON LENDING AGENCY
[—i IWrebyaRrm Nat Nem tsacouwction lendingagency for the Perf..nxuf
tri > the wart for whim this inure t u issued(Sec.3(Y97,Cir.C.) _
L Q Landers Name .
i.)z Lender.Address
U O 1 outify that 1 have rW Ws application W sum than the men irdarmmm is
U. " coria.1 ayme w comply with all city and county onlinanw W state laws reladng in
.17 Wilding construction,and hereby authorize represenatina of this city to enter upon the
[sl above-mentiomed property for inspection purposes.
gy (We)agree to civ,indemnify and tip homeless the City of Cupertino again,
N liabilities,judgmenu,cosuendeapm which may in anywayacrnc againstmid City
U z in consequence of the ynamm,of this permit.
^ APPLICANT UND STANDS AND WILL COM Y WITH ALL NON-POINT Issued by: Date e:5;/"Z T�
SOURCE ONS.
9
De Re-roofs /
Signa of AppliunUConOacar
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applian,he future Wilding ompatuom rehandle haandon material
.fired by the Cupertino Municipal Code.Chapter 9.13,and me Health and Safety
:.Section 25533(a)?
❑yea r'6Ha All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvamou tar cmuminints u defined by the Bay Area Air Quality Mmagemcna all new materials for inspection.
District?
❑yea �hu
1 ban read Ne hauAws makria6 mquiremmtsunder Clu nerb.95 of me Califor.
ma HealNkSafelYCode,Sm6wu25M5.25533 and 255X.1 undersand thuifNc Wilding
Jas cwt cuncndY had•anal this it u my mapomibilitY m serif do occupant of Ne
rtquimments h muss be met prix a C Occupancy.
Signature of Applicant Date
Owner umthon.d.gem Dam All roof coverings to be Class'/W'or better