08060248 CITY OF CUPERTINO + ;• ."' '
BUILDING DIVISION PERMIT CON'TTRACTQR�INFI?vglo
BUILDING DDRESS: PEKMrr NO.
2019 SOMERSET DR SOLARCITY 08060248
NEWS NAME: PERbin ISSUE DATE
KIET NGUYEN 393 VINTAGE PARK DR STE 140 07/08/2008
NE: SANITARY NO. CONTROL NO.
(650) 638-1028
ARCHr1ECTIENGINEER: BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
0 0 0 0
8z LICENSED CONTRACTOR'S DECLARATION
uFI nmcpy affirm that I am lined under pmvidmes of Chaper 9(commwing Job Description
wish satian7(0B)ofDreision 3 ofthe IlWam.std Profcssiw Code.and my scene is 3 .2 KW ROOF FLUSH MOUNT PHOTOVALTAIC SYSTEM
o. in full fonz end If
A-�i Lime Clw - Lie.
n=p Date Cantrssur
ee 7W7W ARCH. 3DECLARATION
.e I uweratand my Plains"I W used a public regia is
k6
ot6 Licensed Profession.]
gt� 3 OWNER-BUILDER DECLARATION
E I Wreby affirm that I oro ezomFt from IW Contrclop License Law for Lim
COO following reason.(Sudan 7013.Business and Profecaiaoa Code:Any cky or county
$pi which requires a permit to conswci,a1¢q W porn,demolish,or repair any structure
prior to its issuance.also requires the Applicant for such Permit in file a signed statement
s< that he is decwdpumarmL to the proviSm.of the Cammetara lJceceve law(Chapur9 Sq.FI.Floor Area Valuation
zl-s (cammcmingwith ScWon7oD0)of Divisian3ofd Busircstmd Prof'om Cada)m $16000
- shat W 1r eumpt therefrom and the basis far Lite alleged nempdms Any violation of
Schon 7031.3 by airy Applicant for a permit subjects Ne applieanuo a civil Penalty of Number Occupancy Type
net roam than fin hundred dollars(ssau). 36930010, P Y yP
❑I,ss ower of the propmy,m my wPloym with wgn a rhes sale campewdon,
and dodeework ante: suueureunotdmndedwaRc does
As A.Busimof
and property
mu Code:The Canassmf, M m Law does net apply m an owner of Required Inspections
pmpeny wyces.pdsodad thaws rnesm ro nmems dausucn weak hires Jrar Wmeghnu
hommu.amaAmplth ea,pravldc unpmwch impmsemmts are net eaeww maBeaeE for sa mer-
b neons.the dm,th, u improvement umld widw otI)ear of cm rowfo,Inc purpose
of
Wilda will haw the burden of proving our W did w dun]a improve for puryme of
ss1eJ.
0 1.u owner of the property aro eaduanly contracting with Iicented¢mamas to
comuvm the project(See 7044.Basin and Professions Cade)The Condacwra i.4
awe Law does rot apply in an owner of property who Wilds or improvm lWrtm.and
who contracts for such projects with 4 eonuaetor(s)licensed pursuant to the Contractors
Liumse Lw.
❑lam aempt under gee •Bk PCfarthisresann
Date
WORKER'S COMPBNSTnON DECLARATION
I Waeby affirm under Penalty of Perjury arc of tier following dalwfam:
❑anThaw arm vDl milnta.aCetufinuof Caaantuself-ituurt fm Warker,Compen-
, on,u provided fm by Section 3700 of Labor Laborr Code,fm r do,peo..of the
wah for which this Permit is inued.
❑1 ban and and maintain Workers Compcwuan Insurance,u required by Sudeba
3700 of Lie Labor Cade lar fm perforce¢+¢.Allan work fm which this permit is issued.
MY Worker,Compemetim hsWmnce carrier and Policy number a¢: 1' -y�
Cartier. tYMQ S�1/' Paltry N..:C&OO7Ot4 la NI
�r FlG�EMPnON FROM WORKERS'
COMPENSATION INSURANCE
musamdon need antbecomplefd ifft permit is fmone henthrdaaRau(SIM)
orf)
1 cetufY that in the Perf--of the wart fm which Asia Permit u issou.I Chill am
employ any perm.in any mamas so As to became subject in the Worker'Compewtion
Lon of California.Due
Applicant
NOTICE TO APPLICANT:If.SRcr making this Ccnifium of Eumption,you should
human subject m f W Waher's Co exuadan leovisimor of the labor Cah,you muss
.J O forthwith comply with such pmvisiw or Nu Permit shildeemed revo
l W ked.
Lei CONSTRUCTION LENDING AGENCY
y.
[-a Ther by which did,
hat Periivacoatrue.30 lending agency for the PerfomanceN
R' > Use wart(a wnich INS pemilu tarot(Sec.J041,Civ.C)
W 0 Isndars Name
� 2 Lewers Addnes,
U Q 1«Nfy Net I lura read Lies applicauan and use that the man information u
pa,5 correm 1+Iasi to comply wish L]city And county oNirurw And Stan Ian relating to
C) Wilding construction,arm berebyauthorin mpmsennuns of this city as new upon use
W aWn-mcad.m Property far inspecean pda,ma
(We)agree to an,indemnify and keep hatm]ea Use City of Cupertino jan,
WA Iiabilida.jwgmmts,coin And e.,anam which may in any way WOma agaiat sett City
U Z in eonmqucnce of the graving of this Permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAMONS.
�R.f'1,1AD. hw V-01 O"?-D3-p5 Re-roofs --
Stgwurt of AppbaHAZARDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
WiB she a Cupertino
m(come Wilding resonant.ChpGore m haw].Hardoa mamrety
ss defined by she Cupenlno Municipal Coda.Chapter 9.Iz,and IW Hailth and Safety
I
seeuoa zss3z(,)Y All roofs shall be inspected prior to any roofing material being installed.
'0Yes 1X1 NuIf a roof is installed without first obtainin an ins ection,I a ree to remove
Will the applicant or ruwre Wildin6 oavpant tie equipnt m dcviw whim g P gha�aus air contaminants a defined by IW Bay Area Air Quality Management all new materials for inspection.
0Yn1 ban real the Waste.mauriadmqimanu underChapurd.95ofthe Cilifor-
ca"SafelyCade•Secuw 25505.25533 aw25534.1 understand fatiftho Wilding
oat cumntly ban a mnam,Wt it u my rtspa d,hility m angryshe oampam of fe wwhkhmuRW^�tP..M aeaaof.cartir .Ofucup..,. Signature of Applicant Date
o Pnt�10 f JCtli/1 022OLEXC
Owner Or aushordmd agent Dam All roof l:overings to be Class'%?."or better
1