08120088 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10373 ANN ARBOR AVE REC SOLAR,
"°TEA'S NAME: PERMIT ISSUE DATE
PHO SAAt� CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
SOLAR PV SYS FLSH MNTD D D D D
u o c LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code.and my license is
y in full force and effect. l
�Z License Lle•x
Date — Contractor O C-
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
D U
Licensed Professional
ti 3 OWNER-BUILDER DECLARATION
qqy I hereby affirm that I am exempt from the Contractors License Law for the
ip O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
u g g which requires a permit to conslrueL alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement
–Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Fsc
Y f•- (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and dee structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code: e The Contractors License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-
cense Taw does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
0 I am exempt under Sec. B&P C for this reason
vner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workees Com aatio4lnsunnce Wirier and Policy umber arc:
Cartier. ��� Policy No.: F7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for ono hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
cn
[~i I hereby affirm that there is a construction lending agency for the performance of
tri> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
Lenders Address
U C) I certify that 1 have read this application and state that the above information is
4L�' cored I agree to comply with all city and county ordinances and state laws relating to
Vbuilding convection,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes
W
W (Wc)agree to save,indemnify and keep harmless the City of Cupertino against
Ow
In liabilities,judgments,costs and expenses which may in any way accrue against said City
U.Z in consequence of the granting of this permit. Date
r"r APPLICANT UNDER ND 4D L COMPLY WITH ALL NON-POINT Issued by:
34��t�zw
SOURCE REGU
Re-roofs G7
f/
Signature Appli t/Co tor Date Type of Roof
OUS MATERIALS DISCLOSURE
Will the applicant or�Fo
lrccupant store or handle hazardous material
u defined by the Cupertino de.Chapter 9.12,and the Health and Safety
^.ode,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yes
Will a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as ncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 undctsiand that if the building
docs not currently have a tettent that it is ponsibility to notify Use occupant of dee
requirements be nfacerir IfGcl Signature of Applicant Date
�- All roof coverings to be Class'J `'or better
Owner o uthoriage Date