08040090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFUt.MATI( ':
BUILDING ADDRESS: PERMIT NO.
21.905 MEADOWVIEW LN AKEENA SOLAR, INC 08040090
R'S NAME: PERMIT ISSUE DATE
dARKEY STANLEY C AND STEPHANIE 16OO5 . LOS GATOS BLVD 06/13/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
INSTALL 28 ROOF MOUNTED BO ELECT PLO O
0, LICENSED CONTRACTOR'S DECLARATION Job Description
uF 1 tereby sffism that am fiend under provisions of Chapter 9(comncesm, ^-^^^^—^^ ^^ —__-- P
`j with cfiion 9fl(IU)o(Divlsion 3 of Ne Business and Professions Cade.and my license is
in full forte and effect cter O 7
3 2 Z Lice nic lav Lic.g
Conn.EC
ARCHf1ECTS DECLARATION
u I underaund my plans sbi ll W used w Public mecoNs
M
s LLa y Licensed Profesamnal
5 OWNE0.-BUtIDE0.DECLARATION
I hereby aRfm Nat I am exempt from the Contractors License Law for tW
L mo following msss son.(Section 10313,Busineand Pmfessiam Code Any city or county
S_ which requires a permit in construct alar,improve,demolish,nr repair any m scm.
im prior In is issuance,aeu requires the applicant for such permit in rile a signed stsmment
< that W is licensed pursuant to the provisions of the Comracmrs Llcene Law(Lnapct 9Sq.FFlFloor Area Valuation
i (commencing with SalionJB)())of Division 3 of the Business and Professions Code)or
wthat W is exempt thmefmm and the buts for the alleged exemption My violation of
Section 10313 by a,applicant for.permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not mom thin five hundred dollar.(ML P Y YP
❑4 w owrcr of IW pmperty,>my wploym with wags u thew cele eompenution,
will do IW wart and the stmctum isnot inmnded ter offered fora.W(Sec.106/.Busiws
and Predations Come The Conuavor's License law don ret apply be an awns of Required Inspections
propeny wW buildsaimposes therrun,and who doessuchworkhimselfmminoth his
awe employees,provided that such improvements art not intended oro@red for sale,if,
however.the building or improvement is sold within arc year of mmplcuon,the matter.
builder will have the burden of moving Nat W did ret Wild or improve for purpose of
um.).
1.as comer of the property.im exclusively contracting with Bcem nt comsanas to .
mnsmarl the project(See 7044.Business and Professions Code:)The Cantraemrs Li.
cone law does not apply to an owner of property who Wilds or improves t emon.and. ...
wW contracts for such projects with a centractor(s)licensed puwant to f Contrhemrs
License Law.
❑l em exempt under See .""C for this reason
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby airmen under penalty of perjury arc of the following declwions:
❑ehaw andidemorinaum,3 roof Consentr ode.fure for Workers Compeo-
worm,r povidnd for mi Secuon 31110 of tie labor Code,for tins performance of the
work for which this permit is issued.
I
have and will mahout.Workers Commotion I.,as required by Section
3 ofIW LaWr Codc,for the prfxommecofthe work farwhich this permitis issued. '
My Wmkx_f(•1re- Q x}O- mppensali can`¢artier and Policy nu��m�b2im,�Q: /�'�
Cartier: /e yrs Policy No.:�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section tried Out W completed if the Permit Is for arc hundred doRan IS IM)
or less.)
1 certify that in the performance of the work for which this perm,is issued.I shall not
employ any person in any manner an as to Wcome,subject to the Workcn Compensation
Laws of California Date
Applicant -
NOTICE TO APPLICANT:IL after making this Ceni(mam of Exemption.you should
become Subject Is the Workers Compensation previsions of toe labor Code,you mom
.J z forthwith comply with such previsions or this permit shall W deemed revoked.
'Zw.' CONMUC71ON LENDING AGENCY
[—m T Wreby.115.that there I..consobethm lona ing agency for the'if..of
CL Ne wart for which this permit W issued(sec.3097.Civ.Q
ryW Isndees Name
D z Lender's Address
V Q 1 cestifY that I hese read Nix application and stem that the alcove inlmm ntim is
gp E' conecL 1 epee m comply with sit city and county oNlwmes and sum laws relating m l
.l7 Wilding consuuctum.and hereby awhonre mpresented.of this city to enter wpm.tic
F yC.) above-mondmned property for impassion pugwes
(We)agree be ware,indemnify and hep harmless the City of Cupertino against
CA liabilities judgments,coma and expe.ti s which may in any way amuse agaieat said City
C)z in Counci sec of the granting of this permit. a
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �_,3_d 0
SOURCE REGULATIONS.
signa,6�fAppucaut C r Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future Wilding occupant once or handle hwudons...HA
fined by Ili Cupnino Municipal Code.Chapter 9.13.and f Health and Safety
.pre.25532m)? Xn. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding oavpant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardnus air conuminants to defined by tW Bay Area Air Quality Management all new materials for inspection.
District? P
❑Yes �Nu
trove mad thehvardmuamamriaW fixommems undcrChapter6.95 of the Caller.
ria Hcalthk Safety CaM,Somma,23505.23533 and 25534.1 understand thuifdm Wilding
does ret,mormly have•tenant dot it is my responsibility In notify the Occupant of the
requirements which mumW mel prior m issuance ofa Certificate or ocevpme,. Signature of Applicant Date
, f�Z� �06?
Owner or authameDateg
All roof coverings to be Class'A:"or better
it
agcn "
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFUt.MATI( ':
BUILDING ADDRESS: PERMIT NO.
21.905 MEADOWVIEW LN AKEENA SOLAR, INC 08040090
R'S NAME: PERMIT ISSUE DATE
dARKEY STANLEY C AND STEPHANIE 16OO5 . LOS GATOS BLVD 06/13/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
INSTALL 28 ROOF MOUNTED BO ELECT PLO O
0, LICENSED CONTRACTOR'S DECLARATION Job Description
uF 1 tereby sffism that am fiend under provisions of Chapter 9(comncesm, ^-^^^^—^^ ^^ —__-- P
`j with cfiion 9fl(IU)o(Divlsion 3 of Ne Business and Professions Cade.and my license is
in full forte and effect cter O 7
3 2 Z Lice nic lav Lic.g
Conn.EC
ARCHf1ECTS DECLARATION
u I underaund my plans sbi ll W used w Public mecoNs
M
s LLa y Licensed Profesamnal
5 OWNE0.-BUtIDE0.DECLARATION
I hereby aRfm Nat I am exempt from the Contractors License Law for tW
L mo following msss son.(Section 10313,Busineand Pmfessiam Code Any city or county
S_ which requires a permit in construct alar,improve,demolish,nr repair any m scm.
im prior In is issuance,aeu requires the applicant for such permit in rile a signed stsmment
< that W is licensed pursuant to the provisions of the Comracmrs Llcene Law(Lnapct 9Sq.FFlFloor Area Valuation
i (commencing with SalionJB)())of Division 3 of the Business and Professions Code)or
wthat W is exempt thmefmm and the buts for the alleged exemption My violation of
Section 10313 by a,applicant for.permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not mom thin five hundred dollar.(ML P Y YP
❑4 w owrcr of IW pmperty,>my wploym with wags u thew cele eompenution,
will do IW wart and the stmctum isnot inmnded ter offered fora.W(Sec.106/.Busiws
and Predations Come The Conuavor's License law don ret apply be an awns of Required Inspections
propeny wW buildsaimposes therrun,and who doessuchworkhimselfmminoth his
awe employees,provided that such improvements art not intended oro@red for sale,if,
however.the building or improvement is sold within arc year of mmplcuon,the matter.
builder will have the burden of moving Nat W did ret Wild or improve for purpose of
um.).
1.as comer of the property.im exclusively contracting with Bcem nt comsanas to .
mnsmarl the project(See 7044.Business and Professions Code:)The Cantraemrs Li.
cone law does not apply to an owner of property who Wilds or improves t emon.and. ...
wW contracts for such projects with a centractor(s)licensed puwant to f Contrhemrs
License Law.
❑l em exempt under See .""C for this reason
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby airmen under penalty of perjury arc of the following declwions:
❑ehaw andidemorinaum,3 roof Consentr ode.fure for Workers Compeo-
worm,r povidnd for mi Secuon 31110 of tie labor Code,for tins performance of the
work for which this permit is issued.
I
have and will mahout.Workers Commotion I.,as required by Section
3 ofIW LaWr Codc,for the prfxommecofthe work farwhich this permitis issued. '
My Wmkx_f(•1re- Q x}O- mppensali can`¢artier and Policy nu��m�b2im,�Q: /�'�
Cartier: /e yrs Policy No.:�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section tried Out W completed if the Permit Is for arc hundred doRan IS IM)
or less.)
1 certify that in the performance of the work for which this perm,is issued.I shall not
employ any person in any manner an as to Wcome,subject to the Workcn Compensation
Laws of California Date
Applicant -
NOTICE TO APPLICANT:IL after making this Ceni(mam of Exemption.you should
become Subject Is the Workers Compensation previsions of toe labor Code,you mom
.J z forthwith comply with such previsions or this permit shall W deemed revoked.
'Zw.' CONMUC71ON LENDING AGENCY
[—m T Wreby.115.that there I..consobethm lona ing agency for the'if..of
CL Ne wart for which this permit W issued(sec.3097.Civ.Q
ryW Isndees Name
D z Lender's Address
V Q 1 cestifY that I hese read Nix application and stem that the alcove inlmm ntim is
gp E' conecL 1 epee m comply with sit city and county oNlwmes and sum laws relating m l
.l7 Wilding consuuctum.and hereby awhonre mpresented.of this city to enter wpm.tic
F yC.) above-mondmned property for impassion pugwes
(We)agree be ware,indemnify and hep harmless the City of Cupertino against
CA liabilities judgments,coma and expe.ti s which may in any way amuse agaieat said City
C)z in Counci sec of the granting of this permit. a
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �_,3_d 0
SOURCE REGULATIONS.
signa,6�fAppucaut C r Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future Wilding occupant once or handle hwudons...HA
fined by Ili Cupnino Municipal Code.Chapter 9.13.and f Health and Safety
.pre.25532m)? Xn. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding oavpant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardnus air conuminants to defined by tW Bay Area Air Quality Management all new materials for inspection.
District? P
❑Yes �Nu
trove mad thehvardmuamamriaW fixommems undcrChapter6.95 of the Caller.
ria Hcalthk Safety CaM,Somma,23505.23533 and 25534.1 understand thuifdm Wilding
does ret,mormly have•tenant dot it is my responsibility In notify the Occupant of the
requirements which mumW mel prior m issuance ofa Certificate or ocevpme,. Signature of Applicant Date
, f�Z� �06?
Owner or authameDateg
All roof coverings to be Class'A:"or better
it
agcn "