08100019CITY OF CUPERTINO
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BUILDING DIVISION PERNIIT
INFORMATION'
.CONTRAC:yTOR
N
BUILDING ADDRESS:
PERMIT NO.
21373 DEXTERREC
SOLA INC'
'.R'S NAME:
PERMIT' ISSUE DATE
pryp
A O. CONTROL NO.
(888)657-6527
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section )010) ofoivaion 5 of dm Business and Professions Code. and my license k
Inf ilraree aed eff s `l2
SOLAR PV SYSTEM MOUNTED FLUSH ON ROOF
Liaense as Lk. R
Dam — Corramnt
ARCHITECTS DECLARATION
1 undersand my plans shall he used a public wcerds
Licensed Pmrcssional
OW NER-BUILDER DECLARATION
I Wmby efOrm Nat 1 am exempt from ted Conuuso's License Law for du
following reason. (Section 70513, Business and Professions Cade: Any city or county
which requrm a Permit m cm.umm, after. improve, demolish. m repair any mau to n
'
print m Its Issuars., also requires the ,,heron (mach perlaim m file a signed saLLMment
Ft. Floor Area
Valuation
than he is licensed pursuant mdre provisions of the Conuamr's UanseLaw (chapter 9
Sq.
(commencing with Section ]000) of Division 5 of the Business and Professions Code) or
32 0 0 0
that he u exempt dtere(m s and the has for the alleged emmption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by ary applicant far, permit subjects the applicant m n civil pen.hy of
nom more don five hundred dogno, (SSW).
32641[)87.()()
❑1,mawmrrofthe property, army employees with wagsuNe'v rola cmnpewtim,
Required
wig mNework.and Neaaaaurebrunimended "offered fmwe(Sm.yoe.,Business
and Plofeykns Cade: The Conmarorr LiRM1x Law does Out apply m m owner of
q p actions
property who Wilda osmlmoves dee'eem, and who doesmch wort himWforNmugh his
woemployera, provided dead such improvements ere not intended aroBered forsale. If.
however, the Wilding or improvement a mid within arc year or connotation, the manner -
tougher will have Be, Warden of proving that he did rot build a imprme for purpose of
sale.).
❑ I. as armor of dee property- am exclusively cwuacting wide Restated controusears N
construct the project (Sec. 7044, Business and Professions Cade:) The Contram es W.
Cense Law doG nut apply m an turner of property who Wilds or asprom el than am and
who antama sermeh projects with. eonaamm(e) ga and parmam m the ennaamm•,'
. .
License Law.
lamexemptundr Bee .Bit PCrathareamn
Date
WORKER'S COMPENSATION DECLARATION
1 hereby am= under penalty of perjury, am of the following dclontions,
1 haw and will malnuin a Cmifiam ofComent m self -insure fa Workers Compete
saedona as provided ram by Seen= nW of the Labor code. fa the performance of Ne
work for which Nu permit u Israel.
❑ I have and will andante Workers Compensation Instant=. as required by Section
57W of the Laba Cads, fm tho performance of the work for which this permit u issue.
My Warke+ys, Cam�v `motion soutanes amu and Paliry umber art:
Carrier. Y'fr'Ca(hJl L�.VI
EXEMPTION FROM S
CERTIFICATECOMPENSATION
I E
COMPENSATION INSURAN�
mus section need rut W completed if the permit is foroac hundred dog= ($I W)
or les:)
I certify that in Use performance of the work fa which this Permit u issued. 1 "I not
employ any person in my maercr m a m became subject m the Workar'Compensation
Laws of Califomis Dam
AppOont
NOTICE TO APPLICANT: If, after making Nu Ccdfmam of Exemption, you should
become subjem m the WortcYs Compensation previsions of the Lahr Coke, you an=
comply with such Provisions m this permit shill he dammed revoked.
CONSTRUCTION LENDING AGENCY
1 herby.Rimm that Nem u, conmoun dem lending agency for the performance of
the work for which this permit u issued (Sae. 5091. Civ. C.)
Lenders Name
,
lenders Address
1 sonify that 1 have mead Nis application and sum that tho shove Information is
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contest. 1 agree to comply with all city and county ordinances and sant laws relating to
WBding conswction.and hereby mmona, representatives of this city to cnmr upon do
.have -s andam.M Property fa impcnims purposes
.
(We) agree m ave. indemnify ad kap barmkas dee City of Cupertino .guest
liabilities, judgments; cava and expert^s which may In any way arca against said City
in consequence of the granting of this permit.
APPLICANT UNDE ANDS A W Y WITH ALL NON -POINT
Issued by:S Date-`�,y%/
SOURCEREGU
Re -roofs
Type of Roof
`
Signsusptif Appfiant/Conux Data
HAZARODUS MATERIALS DISCLOSURE
Will the appliant a future Wilding occuPmt Bore aromatic haardam material
Beed by dee Cupertino Municipal Cod. Chapin' 9.13, and the Health and Safety
a, us..35553(')' �-
All roofs shall be inspected prior to any roofing material being installed.
0yewtl
a roof is installed without first obtaining an inspection, I agree to remove
thc.Ppliantnr future Wilaimgaxuwntaxegaipment«avis, whichIf
emit haves mus air cunuminana a dfrmed by Ne Bay Area Air Quality Managcmcnt
all new materials for inspection.
District?
❑Yes DIP"
I have read dee haardoa materials regoirenmm under Chapmr6.95of the Calif.-
. eras Safety Codc.Saticw 255051 25 and255I he building
due. rest aarrewy have , mcoatss that a' rmpo .pant or l,e
notcur IF
mquiremenu which m met Oromp�'.,
Signature of Applicant Date
�z
All roof coverings to be Class 'J{" or better
Owner., Dam'
uthan.d.gens