01070087 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11723 DOROTHY ANNE WY 01070087
OWNER'S NAME: APPLICATION SUB DATE
]OOP VERBAKEN 07/19/2001
PHONE: SANITARY NO. CONTROL NO.
q Q ZZ ARCHITEC iENGINEER: BUILDING PERMIT INFO
8L' BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Z Z'4- I hereby ffmn Nm 1 San licensed under r Chapter unmmenein Job Description
O Z-o y a provisions o p g
I-_ with Scetinn7000)ofDivixion3ofthcBusinessadPof siomCodc.endmyliccnu INSTALL SOLAR PANEL PV SYSTEM.
'a uin full farces rcec '-,.
cenxe un.« 3
a�3 LL Dam Cantrecmr
ARCHITECT'S DECLA
C t=v,< I understand my plans shall he used ss Pope rtcools '
WN
i p O Licensed Professional
OWNER-BUILDER DECLARATION
to I hereby affirm that 1 am exempt from the Convns Co License Law for the
C Z a following reason(Sermon]BJLS,Business and improve.
de Professions Code:Any city or county $25600
E�v which requires a permit m construct,alter,improve.demolish,or repair any structure
63?. Porw licensed
theapPmuns for such License
Laedemremcm.
(cmmenti gwit Sedan 700 po�Divisims nf the Cnnwnofs roulse Lew(m Ciadi9 ! Co F IIp a I Valuation
(commenting ciiipt t°-700im of Division gafine Buwncss ndPm.Anions Cade) L't};y33.6�@54t11� U� Yt:��f!.d?.4'
or that he IS eeempi Ihc2rrom aM the basis for the alkgeJ ekempdm.Any violation dAL.v i
-nf Seai°n]031.5 by nny upplirnm fora permit snmjens the applicvm In a civil Penahy '
of nnmore than five hundred dollars(S501p. 304APN kd I ELECTRICAL' _Occupancy Type
❑1,ss owner of Nc PropenY•or mY employees with wages ss their sole compensation,
will do the'work(and the sweture is not intended or'olfered for sale(Sec.7041;'
'Business and'Professions Code:The Contmcmr's License Law does not apply in an 505 - FINAL ElFMR Aj9 ctions
owner of property Who builds or improves thereon,and who does such work himself 1
or through his own employees,provided that such improvements arc not intended or
or
salmi If,howevee the buildin8 or imPFaKmcm is sold within une year of
eumpletion,the owner-builab r will have the burden of proving than he did not build or ._.1
improve for purpose of sale J.
U. .°I us owner ofhep penYexclusively contortion,withl- - dm.tor,in
wet
he p oject(Sec 7044 Bu iness e d Professions Cade)The Contractor', a
License law docsfi pn ar net of property h W Ids se pros th n
_and h trecu.(or s.cuch.prolats w Ih corrections)licensed pursuant m the
iiiiin.Loct 11
j- '
❑1 am exempt under Scc. f" "," ;B&P C far this reason t ..',n,
Own r . ..
Data '. .
• r WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of a jury one of Ne following dechuniumns:
° 1 hove end will maintain'.Cerificute of Consent m self-income for Worker's
Compensnian;-as_Provided for by Sation 37W of the labor Code, for the
performance of the work for which this permit is issued.
°1 hove end will mainmin Workh'e Compmsadon Instirhnce,as mx,mrd by Sectian
37M of Ne Labor Code,for the perhimlmme,of the work for which this permit h,
issued My W k I I C m en inion Insurance came,and Policy number am
n ._. ,,
c e1 zo PwmyNo. 38
1 -7!CERTIFICATION OF •XEMPTION FROMWORKERSCs �fi11{ ..A1S't,rs'.�a.
COMPENSATION INSURANCE;,',"' i
r ' '(This section need not be compinetl if the permit is for one hundreJ dollars
(bltgq or less,) •
-rt t ..... -. .. ., ... - .....«... .. .-
1 c mfy that in the
( ( f
permitt in tIshall employ any prsom in any manner mu'm becomhublec[mthe writers'
Compensation
laws of C5lifomia.Date-'
Applicant
'NOTICE
TO subject in
he Worker'If,s
Commakmglhis Inivil CertificateExemption,d: .itram,
become su ompy the inch pr Gripes r the permit shall
the Lamar Code: .it sett, j
Q fdnhwim comply with inch provisions or this permit sh.11 be deemed revoked. m ,
.E " C6NSTRUCf10NLENDINGAGENCY '�
1 hercbr This In r o t t I ndin8 eget Y for Ne pert ms e t l I et
mm .En of mtleork farwhich
hich m pe t' sued(S Jog] Cis,C.)
y _
.ra -'Lenrs Nume_._. ..�..x.� .. . _ •`'i - . _. . _ _.. _... �.._._ . __, . _ _. _.
;D;Z
IL
C.1 1 certify that 1 have read this application end satin thin the above information is
Lti}E. coheh.I agree In comply.with all cilyaning
nd county ordlnmmes and star,laws reform
V Ir,bit it enn.ancllon,andherebyoulhliriec mprxsenlhdres of this city to enter upon'
r�
!the 1W nen' ncd property 'nspct Pry -
k�y1-P«
(We)tanto m d Ifyunikaph l.s'Ih Chy'fC Pcrl n gins[
:F t4 lib It<. ems r d u h' h. yin any way .,.i,ns[said'
C.7 Z' C ry In ce f Ih gr 1 Ih p rata'
iAPPI UNDERSTANDS IL COMPLY WITH ALL NON�DINT
so L nr 1. - `� a, Issued by: Date
:Stgovme ofAPplic HAZAR IUSMA�(�aN�. Re-roofs
s HAZARDOUS MAT FR1AL5 DISCLOSURE
Ps mate'al. ., Type Of ROOF -
•, WJl the aPnco tort future building shim hantll'h 'd
.as lefined byN Cupertino Municipal Cote Chapter 9A2. d the Health ntl Safery,
Cade.❑Ye ,2553200, sxc,
roofs shall be inspected prior.to any roofing material being installed . .-
i Will the^applicant orfamrebuilding occupant use equipment mm,licexwhich If a roof is installed without first obtainingan'ins ection,'I a„ree to remove
lot !.am,
em t hum rd r cones 'rant'ai deB ed by the Bay Area A Quality Management, P o
Dirt ctall new materials for inspection. Applicant understands and-willcomply.with
°Y °No”,
all nodi-point source regulations.. ,, ;,
x.
I have mail
Cal f m l 'e rat o Is req rent under 695 the,
He Ith'&Sfoy Cod Sections 2505 2553
.3 an2553
4.1 understand
' '
Ihmf '
if th h dd dx-n t n I ha ies fl i i my po h i'ry to noddy rue
s p of he req rc <m h'm t et p no e f u Cenifc t L '
r� Signature of Applicant Date
_. .
ow antnapngd gem t t I DateAll roof coverings to be Class "B"or better
OFFICE