BLD-2024-2696_SignedPermit.pdf ITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10797 BROOKWELL DR APN: 369 21 016
PERMIT NO: BLD-2024-2696
OWNER'S NAME: GORVITOVSKIY YURIY AND GORVITOVSKAIA ELENA
OWNER'S PHONE:
CONTRACTOR: FREEDOM FOREVER NORTHERN CALIFORNIA LLC
CONTRACTOR PHONE:
DATE ISSUED: Nov 27. 2024 ISSUED BY:ONLINE VALUATION: 35048
JOB DESCRIPTION: SOLARAPP+ - INSTALL (15) PANELS ROOF MOUNTED
NEW BATTERY STORAGE (13.5 KW H )
PV SYSTEM (6.15 KW); (1)
NO: EXP DATE: 08/31/2026
1125479
7000) of Division 3 of the Business & Professions
LICENSED CONTRACTOR'S DECLARATION:
CONTRACTOR:
I hereby affirm
Code and that my
FREEDOM
that I
license
under
B GENERAL
FOREVER NORTHERN CALIFORNIA LLC LICENSED CLASS: BUILDING, C10 LICENSED
ELECTRICAL, C46
SOLAR
am licensed under the provisions of Chapter 9 (commencing with Section
is in full force and effect.
penalty of perjury one of the following three declarations:
and will maintain a certificate of consent to self -insure for Worker's Compensation,
Code, for the performance of the work for which this permit is issued.
as provided for by Section 3700 of the
I hereby affirm
❑
I have
Labor
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
I.
I have
and will maintain Worker's Compensation Insurance, as provided for by
of the work for which this permit is issued.
that in the performance of the work for which this permit is issued, I shall
subject to the Worker's Compensation laws of California. If, after making
Worker's Compensation provisions of the Labor Code, I must forthwith comply
revoked.
performance
❑
I certify
become
the
deemed
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
the hazardous
compliance
Management
25533,
materials requirements under Chapter 6.95 of the California Health
M I have read
will maintain
handle hazardous
Air Quality
Sections 25505,
with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
material. Additionally, should I use equipment or devices which emit hazardous
District I will maintain compliance with the Cupertino Municipal Code,
and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
-Safe
Name:
-Safe
Certified Renovator will be responsible for this project.
Firm Certification
❑ An EPA Lead
Certified Firm
✓ No EPA Lead
Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty
(Section AV7, Civil Code).
of perjury that there is a construction lending agency for the performance
No
Yes El
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
2024
I certify that I have
laws relating to
purposes. (We)
accrue against said
source regulations
Signature 1MNN4
read
building
agree to
City
per
this application and state that the above information is correct. I agree to comply
construction, and hereby authorize representatives of this city to enter upon
save indemnify and keep harmless the City of Cupertino against liabilities,
in consequence of the granting of this permit. Additionally, the applicant
the Cupertino Municipal Code, Section 9.18.
COOLIN Date Nov 27,
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.