07100079up j
'duFy
n�i
°h
qhqyO�
coo
r�=
CITY OF CUPERTINO-
C
B
Oforthwith
ti
%
QLender's
Z
O
fV"
F3i
y
tz"
BUILDING DIVISION PERMIT
COl'TYtACOR'IIYEt?TION,+
BUILDING ADDRESS:
10430 MILLER AVE
AKEENA SOLAR, INC
PERMIT N0.
07100079
ER'sNAME:
PERMIT ISSUE DATE
16005 LOS GATOS BLVD
01/03/2008
PHONE:
SANITARY NO. CONTROL N0.
(408)867-0558
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mreby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7")of Division 3 aflhe Business and Pmfessians Cade. and my license is
INSTALLING 16 SOLAR PANELS TO RESIDENTIAL ROOF
in full fort. and.Rcel
License Cla Lk. g
TDa
Dam cast m
ARCHITECTS DECLARA
1 understand my plans shall W used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby alum that I am exempt from the Contractors License Lew for the
following reumn. (Section 703 I.S. Business and Pmfessimu Code: Any city ...early
which requims a permit to construct, alter, improve. demolish, nr repair any structure
prior to its Issuance. also mQalRs dL applim,for such permit to rile a Signed statement
Canu License Law 9
Sq. Ft. Floor Area
Valuation
that is licensed pursuant m the provision of the otos (Chapter
$19936
(commencing with Seeman 7000)of Division 3ofthe Business and Professions Code) or
that M u exempt therefrom and the bask for the alleged exemptian. Any violation of
-
37505040. Number
Occupancy Type
Section 70313 by airy applicant for a permit Subjects the applicant o a civil penalty of
not mom Nan five hundred dollen (5500).
❑ I, u owner of Ne property, of my employeu wise wage u their sok compenadon,
Required Inspections
will do is. .*,.ad thetomoto k act homeded".tiered restate (Sm. 7f W. Busisrcn
and Profession Cade: The Conuwots License Law does not apply or an owner of
q p
properly who buildsorimproves thereon,end who does suchworkhimselfor through his
awnemployess, provided that such improvements ass not intended or o@red forsels. if.
however. the building or improvement is sold within au yew of completion, the owner,
builder will have the burden of proving that M did not build or improve for purpose of
ask.).
o I, as owner of the property, me exclusively, mum usmg with, licensed contractors o
mastmct the project (Sec. 7014. Business and Profusions Code:) The Contractors U.
corse law does not apply o an owner of property who builds or impneve, theater, rod.
who contracts for such pmjem with a eonVwtor(s) licensed pursuant m the ( muesetara
License law.
I am umem under Sec. . B & PC for this mama
Dam
WORKER'S COMPENSATION DECLARATION
I hereby Spires under penury of perjury one of the following decimations:
❑ I have and will maintains Certibcem of Consent o selRimum for Workers Compon-
titian, u provided for by Section 37M of the labor Code, for the Performance of the
wart for which this permit is issued.
I have and will maintain Worker's Compcnution Inaunnce, u required by Section
70D of the labor Code, far the performance of the wed: forwhich this permit Is issued.
My Wmker'.Ornamenationsln�.wnae SShier and Policy number are: _
Carrier. �[', l J r� O Policy No.: 3 —R ° S
CEIMFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thissecelon treed not Wcamplemd If the permit itinerate, hundred dollars ($100)
or Ica)
I worry that in the performance of the work for which this permit is issued. I shall not
employ any Person in any manner se as o became subject to the Workeri Compensation
Laws of Califomis. Data
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become auhjcet o the Workeh COMPICIWtimr provisions of the Liber Cade, you mal
comply with such provision or this Permit Shall W demand revoked.
CONSTRUCTION LENDING AGENCY
I herby alfmn Out then is a construction lending agency for dec performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
'
Name
Leader. Add.
I certify that I have read this application and sum that the above information k
commit. I agree to comply with all city and.aunty ordinances and suss laws totaling m
building construction. and hereby authosiae representatives of this city o enter upon the
&hove -mentioned property for inspection purposes
(We) agree o ave, indemnify and keep harmless the City of CuPmina against
timiliflujudgments.costs and expenses which may in any way accrue agaimlaid City
in
APPLICANT cof the UNDERSTANDS Aof IND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR
Q/d6
Signa AppawnuContrmor Dem
HAZARDOUS MATERIALS DISCLOSURE
Type Of
handle uamamsisi
WillyftCpertino fumtoipal Code,
hanuom2, Health
Rated by the Cupertino Municipal Cade,, Chapter 9.13, roti Ore HcsiN and Safety
Section 25532(s)7
❑ Yes
All roofs shall be inspected prior to any roofing material being installed.
1p"o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit haxudaus air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
o Vcs �Nb
I have mad the harardsws materials requirements underchapetr 6.95 of the Califar-
.I. Health & Safcty Code. Seem.25305.25533 and 25534. I mrdeutsod rharifthe Wilding
does not currently ham a mmnr, that It is my ropoviNlity o notify the ommant of Ne
mquitomc whl.hmmtxmctp. oissuance ofacarti0esoor .n
Signature of Applicant Date
All roof coverings to be Class "B" or better
owns as hart.<d as.n ,m