BLD-2020-1475BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10632 MINE CT Cupertino
APN: 316 47 023
PERMIT NO: BLD-2020-1475
CONTRACTOR: FREE ENERGY SYSTEMS INC, 300 MONTGOMERY STREET #730 SAN FRANCISCO
CONTRACTOR PHONE:
DATE ISSUED 9/15/2020 3:51:45 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $12012
JOB DESCRIPTION
PV SYSTEM - ( 4.42 KW)
(N) 13 - PANEL ROOF MOUNTED
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C46
LICENSED
EXP
12/31/2021
I hereby
force
I hereby
FREE ENERGY SYSTEMS INC
CLASS:
SOLAR
NO: 988918
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of
I have and will maintain a certificate of
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
the following
consent to self
Insurance,
for which
this certificate
be deemed
three declarations:
-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Co lie, for the performance of the
V
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
revoked.
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
9.12 and the
Chapter 6.95 of the California Health & Safety Code. Sections 25505, 25533. and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
v
CONSTRUCTION LENDING AGENCY
is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there
No
N/A
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
against liabilities,
will comply with
state that the
of this city
judgements,
all non -point
'-
.