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CONTRACT(TR it k'RNIATI�1
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BUILDING DIVISION PERNUT
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BUILDING ADDRESS:
PERMIT NO.
.1.01.23 JUDY AVE
SOLARCITY
08070093
NER'S NAME: PERMIT
ISSUE DATE
J 7:M C:I:TTA & GAYLE JARVINEN
393 VINTAGE PARK DR STE 140
07/23/2008
PHONE:
SANITARY NO, CONTROL NO.
(650) 638-1028
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
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Job Description
I hereby affirm than 1 am IlaluW under previsions Or 9 (commenting
with Section 7") of Division 3 ofthc Raimo and Profusions Cods.md my license is
2.46KW RF FLUSH MNT PHOTOVOLTAIC SYSTEM
in full force and eco.
Ixerma Lie. g
52gsal C4
De¢ Comcusar
ARCHRECI'S DECLARATION
I understand my plans shall be used m public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am aempt from the Contractor's License Law for the
following ream. (Section ]8313, Busimas and Professions Codc: My city Or county
which requires a permit to construct. alter. improve, dem ish, or repair any structure
prior us its issuance. also requires the applicant for such permit to file asignW wtemnt
Net he 4Ree«ed to the ofwe Cnnu.emn•s Uccnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pumunt pmHsions
(com rcusing with Section 7") of Division 3 of the Busincessed Proleaiou Code) or
$11000
than be is exempt thertrmm and the basis for loss allcpud es unpuon Any violadun Of
Section 7831.5 by any appiksurn for a permit subjects the applicant to a civil penally Of
Number
�(/N1'Pe
Occupancy
ret more than, five hundred "Its(S588).
375 07052
Le owner of Ne pectate,or withwagsorale'vak emnpeusines;
will do the work and the he Com u not intended License Law do f«sale (Sec. ]Dasa wner oa
is 1mundea
and code: The Contrrt law does not apply lf owner of
Required Inspections
enywixow
rt
who dosauchaork through nu
son. dwho
emplo a WLlda«imgavu dvmn
ve oroffrml
Own Nemd for ala B,
own employes, provided such improvements are net
h.evmilder . the Wilding o pr ts hath our m carr
did me, year orcoroplotiu, the
men of purpose of
builder will nave the bmdm of proving that k did Out build or improve for puryase of
a
ale.l.
❑ 1. as Owns of W property. w aclusively...seting wish licensed mnuacmrs to
personal de, project (Sec. ]Bas, Business and Profusions Code:) The Conu¢mes U.
cense Law does a« apply to an Owner of property who builds Or imprors thmem. and
who concocts for such projects with a eonuanor(a) licensed por unt b she Contractor's
License law.
❑ lamamnptundmseu ,B&PCror Nisreamn
eor Das
WORKER'S COMPENSATION DECLARATION
I hereby Nim mukr pmWty of Pod., Oscar ds fallowing declarations:
❑ I naw aM will mainuio,Cenifinuof Coucnt m e,l(-insure f« Woher's Campers
satin, m provided for by Section 3701 or the Labor Code, for she performance of the
work for which Nu permit is issued.
A3I have and will monad. Wman's Campcuadan To.,, as required by Section
or NC IaMe Code. for NC performance ofohe worc for which NU Permit is iaued.
.
My Worker'. Corropevmcca Insurance carrier and Pull, mnber are:
Cartier. X11 \-1' T'-/"' Polity No. -.Q t00 / O y 1,4
1
�M CERTI CAFI TE��PIION FROM WORKERS
/ r Lt J/ S�COMPENSATION INSURANCE
(Toss#/ usneed, ImtCb_Fcompleed ifthpcmhbroronchundoddolhan(SIM)
or leu)
I wtiry that lo the pmfomance of the work for which this permit is issued. I shall not
mopl%any perm. in .1 mmmrha as to becomC subject to the Wnrten' Compeondes
Lsws Of California Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject m the Wohcrs Compctwuon provisions a the harm Code, you mus
ronhwith comply with such provisions Or this Permit shall be deemed revoked.
CONSTRUCTION L ENDfNG AGENCY
I lottery shim that demi.. co suucunn lending agency for the performanee of
the work for which this permit Is issued (Sec. 389'1. Civ. C)
L.nder's Name
L ombse, Address
1 comfy that I have mad this application and sem duo the above inr«m,uat is
connotes. I agree or comply with all city and county uNiamrs and sue, laws mining to
Wilding construction, and hereby mthorim mproaemauvea of Nu city to color upon an,
+hove-mes Toned pmpeny for inspecut t pmpmes
(We) to indemnify
agree ave, and keep hamlus the City of Cupertino against
liabilities, judgments, low and apes« which may In any way acct« agaion said Cty
in consequence or the [noting mthis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUy�E REGULATIONS.
Issued by: Date —2 2
I1�1��1 fw1D l�D/'1 n '7%r'),Z)1OX
Re -roofs
Signature
Sigure of ApplicaroXonuamor /�—
HAZIRDOUS MATERIALS DISCIDSURE
Type of Roof
Will the applicant Or forum building a«uprm nom ac handle haalloa material
U deRntd by the Cupertino Municipal Code. Chapter 9.12 and the Health and Safety
Om 25532o)? s
Yu LN NO
All roofs shall be inspected prior to any roofing material being installed.
Will the a liaanr or future btrimb «ea am nae
fT L P Nuipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
g PC
CDmfkhaaNns air conumiwn u dented by Ne Bay Area Air Quality Management
all new materials for inspection.
❑Ya o
I have mad the hvardsumatmhla ¢quhcmcw mtdcrC ipnrrti.95 of t eCalifor-
niaHealth&Safety Cadc. Smtww 5585.25533 md25533. lundcuund ohaifde bolding
dm net currently have a barren, de, it u my mspomibiliry us notify de occupant of the
on! Cote which revel rc t 'orwissuaitce ora Cnilkate ar Occu
Signature Of Applicant Date
All roof coverings to be Class '%Q." or better
oum rwmthorisGagent te