BLD-2021-1383_SignedPermit.pdfBUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20573 RODRIGUES AVE Cupertino
APN: 359 10 048
PERMIT NO: BLD-2021-1383
OWNER'S NAME: WANG GENE SHIH-CHING CHIN AND KRISTINE YI-
OWNER'S PHONE: 408-398-7658
CONTRACTOR: TESLA ENERGY OPERATIONS INC, 901 PAGE AVE FREMONT
CONTRACTOR PHONE:
DATE ISSUED 8/1 1 /2021 8:10:50 AM
ISSUED BY: KDUNBAR
VALUATION: $79162
JOB DESCRIPTION
(12.92 kW) ; (N) ENERGY STORAGE SYSTEM (40.5kW)
INSTALL (N) SOLAR (221) TILE ROOF
LICENSED CONTRACTOR DECLARATION
C39 ROOFING, C36 PLUMBING
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
12/31/2022
I hereby
force
I hereby
TESLA ENERGY OPERATIONS INC
CLASS:
SOLAR, B GENERAL BUILDING, C10 ELECTRICAL,
NO: 888104
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one
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
of the following three
consent to self -insure
Insurance,
for which this
this certificate
be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
9.12 and the Health
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
& 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:
is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified Firm
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
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
liabilities,
comply with
state that the above
of this city
judgements, costs,
all non -point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have
construction, and
harmless the City
the applicant understands
Signature:
read this application
hereby authorize
of Cupertino against
and will
H\
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.