08080131 CITY OF CUPERTINO ,,:,-+• +q x .,� �'%"' *� -
BUILDINGDIVISION PERMIT ++�CONTRACTOR=TNFQRMATION .
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BUILDING ADDRESS: PERMITNO.
938 I.11'BERTY CT HORIZON ENERGY SYSTEMS 080801.31.
ERS NAME: PERMIT ISSUE DATE
( !.('!!ARD FASTOW P 0 BOX 32061.2 09/02/2008
PHONE: SANITARY NO. CONTROL NO.
(908) 395-9060
ARCHITECT/ENGINEEK: BUILDING PERMIT INFO
BLDG ELi?L7 PLUMB MECH
1� I�
�o� LICENSED CONfRAClDR3 DECLARATION
Job Description
4 U 1 ion 7 )of Nal 1 am lithe u undernd Pr ioB ofs Come, 9 Antimy
is p
wiNSection]OfIU)ofDivision 3ofNeBunnessaadProressiomCode.aadmylicense, PV SOLAR GLECTRI:C (GRID-T1:L SYSTEM-PAINT FLASHING
O H n full roma emd 0
q p Beau. "� A.uhaNr -Of - TRIM TO MATCH ROOF' COLOR.
ey�� A0.CNM(---DECLARATION `, y S
WU 1 me mond my plaos Nall W hand u public mcmds / Sf re
ave
mo Licensed Professional
OWNER-BUH.DER DECLARATION
I hereby a1Rrm Net I em a crept from de Conhactnrs Liccase Law for IW
0 O following mason.(Section 703 1.5,Business and RofcuioB Cade:Any city car county
$(Li which rtquires•pumit m ounumnm,a1mr,improve,demol,h,or mpnr any sumeture
_2w prior N in ismance.we mqulma BC applicant for wth Permit N Bk a signed snlCmem
Nm he is licensed pursuant t.Me'ovisimsofMeCommunes License Law(Chmic,9 Sq.Ft. Floor Area $38633
Valuation
OW
(commencing with Section] )of Division 3 of Ne Business and professions Code)or
9 Nat M is esempt deterrom and Ne basis for the alleged acmption.Any violation of
Section 703M by M applicant for a permit subjects the applicant to a civil penalty of �,p�Number Occupancy T
ba mem Nan five hundred dolws(SSM 35611067 .'(7'ty' . P Y yPe
I,u owner of tW popmy,m my wployces with wegu u Me'vsole eompensatian,
Will do Mm wort.and Nestmerm,is not intended conflicted(mule(Sec.]Odd,Business
and Prorrssions Cade:The Co tummes License Law does ret apply N an oohar or Required Inspections
propertywW .providedMtuch impmendwho tltesamhwork himaelrer Waugh hu
ownver.th Wilding
prsuchimpsovemansart not ineadndmoQertA for vale If.
however.the eth m improvement,sold within one year or improve,
for de owner.
Wilder HB love W burden of proving Nal W did Out ddid or improve far puryom of
stale.).
❑1.as owner of Ne property am caclusively contracting with licensed aonuhaMon N
cuastrmt de project(Sec.NM,Business and ProfessioB Code:)Ile Ccommus is I.I.
cease law does not apPIY to an owner of property who Wilda or improm Neuron,and,
who contras for such Pmjees With a chnUacmr(s)licensed pursuant N the Cnmractors
Lice.Law.
Ismuemp anderSee .B&PCI.Nifmason
Das
WORKERS COMPENSATION DECLARATION
1 hereby air,.under penalty°(pujmy me of Ne following declarations:
❑1 haw and WII malnuin•CmUfieste of Chmm�t N self-IBurt fm Wmkers Compere
satire, provided fpe by is
named,ma.moo car IW Labm code,far W peAormame of W
work forr which N,premia.,issued.
N�I'havc and will maintain Workers Compmumlon Iasurutce.as mobbed by Section
37W of Ne Later Code,for Ne performance of the work for which this Permit is isshad. '
My Worker's Compensation Inquiries,oriu anal Policy number am:
Cartier. 11
. OX PolicyNo.:�/3 rJO27 5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectim hand Out W cmnpleled J W pcsmit,foronehmmmed dollars($100)
Or tut)
I certify Nat in Ne Performarec of the work For which this Permit,leaned,I shall not
employ any person in any master w as N become subject N W Woskcn''Compeuadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject he the Worker's Compemntion provisions of W Labor Cade yen mut
.,O faMmwilh comply with such provisim m N,puit mshall W deemed mokcd.
'E'er) CONSTRUCTION LENDING AGENCY
[-r r 1hemhy af@m Nat More is.commtetinn lending agency for Ne performance or
Ci Ism wort for which N,permit is issued(Sec.3097,Civ,C.)
W A Lenders Name
z Leader,"Mens
U 0(.., 1 cenify that I have read Ws application arta sus Nat the a m.infmmmiun is
IL, V tercet.1 agrR be eme'ly with all city and county mllBrlaneCl and state laws relating N
'0 Wilding comNan
ruon,and hereby humen rePmsenstim m ofaw city enter upon the
W aWve-mentimed property rte inattention Purposes,
' G (We)agree to save,indemnify and keep bmmlems Ne City of Cuperino agnnst
VS
liabilities judgments,roses and expensns which may in any way accrue agm,a end city
t.)z in consaq of Nc granting of Nt
is Permit.
APPLICANTN'r UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:Y Dale
Jignmure o— Apphccai uComC Tactor �� Re-roofs �7
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or Intent,Wilding acupantaom an,handle handout maNdal
as deBnnd by the Cupertiw Municipal Code.Chapter 9.12,and Ne Health and Safety
.s�JY"2553x.>7 .moo All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection,I agree to remove
Will Nc applicant or/more building mcupam sax rquipment m devices which g anns P
emit hazmlOus car conuminants u defined by the Bay Area Air Quality Management all new materials for inspection.
DishinP
❑Yes
I haw mad W bmamwamaerialsmquimmcns under Chapmr6.93 hI W Califor-
m-Heap"Safey Coad.Smvans 35303,25533 aud 25534.1 undcomed thuifdc Wilding
does not currently have a tenant Mut it,my maponsihility m notary the oceno.,of the
rt,quirt wmch muv met prior m" cnifeae of�(lc
_ r ( Signature of Applicant Date
0
Owner Lir amhorve cm D,e- All roof coverings to be Class's!'or better q