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CITY OF CUPERTINO
BUILDING DIVISION P RINM
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BUILDING ADDRESS:
P[RMrr NO.
19720 DRAKE DR
SOLARCITY
OWNER'S NAME:
PERMIT ISSUE DATE
PHONE:
A COMROL NO.
(650) 638-1028
ARCHITECrfENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I an licensed under provisions of Chapter 9 (commemIn;
P
with Section 7000) of Di=ln 3 of the Business and Professions Coda• and my license ls
in full farrzand
2.46KW ROOF FLUSH MNT PHOTOVOLTAIC SYS,
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Dale Contractor
AR S D O
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Conliwors License Law for the
following reason. (Section 70313. Business and Professions Code: Any city or county
which requires a permit to construct, alar, improve• demolish, or repair any structure
prior to is issuance• also requires the applicant forsuch permit to fnlc a signed ssatemeat
chat he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Businesv and Professions Code) or
that be is exempt therefrom and the basis for the alleged exemption. Any violation of
$12000
APN Number
Occupancy Type
p y yp
Section 70313 by any applicant for a permit subjects the applicant to a Cavil penalty of
not mote than five hundred dollm (5500).
316 3 2 019.0 0
❑ L as owner of the property, or my employer with wages as their sole compensation,
Required Inspections
will do the wort, and the structure is not intended or offered for scab (Sec. 7044, Business
and Professions Code: The Comtncters License Law does not apply to an owner of
property who builds or improves thereon. and who does such worst himscl o through his
Own employees, provided that weh improvements are not intended or offered for sale. If.
however, the building or improvement is sold within oro year of completion, rhe owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the Iropety, am exclusively contracting with licensed contractors to
construct the project (Sex. 7044• Business and Professions Code:) The Contractors Ll -
cense Law 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.
❑ I am exempt under Sex. B & P C for rhs mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workeea Compan-
anion, as provided for by Section 7700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of rhe Labor Cada, for the performance of the work for which this permit is issued
'
My Workers,
Na.:
CERTIiICA37E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihs section need not be completed U the permit is foram hundred dollars (Sloo)
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 Dam
Applicant
NOTICE TO APPLICANT: U. after making this Certificate of Exemption, you should
become abject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby amrm that there is a construction lending agency for este performance of
the work for which this permit is issued (Sec 3097, Civ. C.)
Lenders Name
Lenders Address
I testify that 1 have read this application and sats that the above Information is
correct. I agree to comply with all city and county ordinances and state laws relating te
building construction, and hereby authad a representatives of this city to enter upon the
above-mentioned property for inspection purposes
(vee) agree to ave, indemnify and keep harmless the city of Cupertino against
liabilities. judgmenta.costs and expenses which may in any way accrete against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POLNT
n
Issued by: Date
SOU • REGULATfON
Re -roofs
—
Type Roof
Oak
HAZARDOUS MATERIALS DISCLOSURE
of
Will the applicant or future building occupant store or handle hrardors material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 25572(s)7 t
❑Yes IL-1 No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant we equipment or devices which
emit hazardous air contaminants as de0ned by the Bay Area Air Quality Management
all new materials for inspection.
Dstrict7 //''
[3 Yes V No
I have read the harAr nus materials requirements under Chapter 6.95 of the Califor-
ntiaHeallh&Safety Code. Sections 25505.25533 and 25534.1understand that tribe building
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docs riot currently have a tenant. that it is my responsibility to the occupant of the
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mquimmemts which mast be met prior to issuance of a certificate of Occupancy.
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Signature of Applicant Date
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All roof coverings to be Class '%�" or better
Owner or authorized agent te