081001380
Z2
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
I�TIo�
s.. t
BUILDING ADDRESS:
PERMIT NO,
22324 CARTA BLANCA ST
SOLARCITY
ngionlig
OWNER'S NAME:
PERMIT ISSUE DATE
PHONE:
CONTROL NO.
(650) 638-1028
ARCHITECT/ENGINEM
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
licensed Chapter 9
Job Description
I hereby affirm that I am under provisions of (commencing
with Section 7000) of Division 3 of The Business and Professions Code, and my license is
full ffna derf
REV; CHNG CONFIGURATION; ORIG #08080126 ,
_iQLin
Date C� O Contractor
'
ARCHTTECI'S DECLARATION
1 understand my plain shall be used as public records
Licensed Professional
OWNER-BUIL.DFR DECLARATION
1 hereby affirm that I am exempt from the Contractor's tJcenw Law for the
following reason. (Section 7031.5. Business and Proft.Wons Code: Any city or county
which requires a permit to construct. alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
dirt he is licensed pursuant to the provisions of the Contractor's Licensc Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
10 0
that he is exempt therefrom and the basis for the alleged exemption Any violation of
0 -
APN Number
ant
Occupancy
P Y Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (SS00)-
32613043.00
❑ L as owner of the property, or my employees with wages as their sole compensatino,
Required Inspections
will do the work, and the structure Is not intended or offered for sale (Sec.7044. Business
and Professions Code: The Contractors License Law dots not apply to an owner of
properly who builds or improves thereon, and who does such wort himself or through his
own employees, provided that such improvement& are not Intended or offered for sale. If,
however. the building or improvement is sold within one year of completion. the owner.
bullder will have the burden of proving that he did not build or Improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with Bcensed convectors to
construct the project (Sec. 7044, Business and Professors Coda:) The Contractor's Li.
tense Law does not apply to an owner of property who builds or improves thereon. and.
-
who contracts for such projects with a contractors) licensed pursuant a the Contractor's
L actnse Law.
❑ I am exempt under Sec. , B & P C for tlds reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -Insure for Workces Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
3700 or the Labor Coder, for the performances of the work for which this permit it issued.
My Worker's Compensation b ensatitnrce ancarrier and Policy number am:: / 2 r ,
Card 1 nYiYlCii�olicyNo.: WC6UQ� J 16
CO
er%�tr1L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If the ptxmlt is for one hundred dollars ($100)
.
or less)
I certify that in the performance of the work for which this peril is issued, 1 shall not
employ arry person in any manner so as to become subject to the Workers' Compensafion
Laws of Caliromia Datc
Applicant
NOTICE TO APPLICANT: If. after making this Certificate or Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this peril shall he deemed revoked.
CONSIRUCIION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec 3097, Civ. C.)
L.endces Name
,
Lender's Address
I certify that I have read this application and sate that the above Information Is
'
correct 1 agree to comply with all city and county ordinances and sate laws misting to
building construction, and hereby authorize representatives or this city 10 enter upon the
above-mcnuoned property ror inspection purposes.
(We) agree to saw, indemnify and keep harmless the City of Cupertino against
liabilities, judgments,costs and expenses which may in any way accrue against said City
' in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date2-�'Z to
AP
SOUR E REGULATIONS. 1
i012-y /CO
Re -roofs
Type of Roof
Signature of Applicant/Contractor Dire
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or rutum building Dccupantstore or handle hazardous material
as drained by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely
Code, Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes .{f NO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devisers which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes $Ao
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hoalth&SafctyCodc, Sections 25305,23533and 25534.1undcrsandthatlrthe building
dins not currently have a tenant dot It is my msponsibility to notify the occupant or the
requirements which must bq m t 'or toissu or acemr,rate orOccupancy.
Signature of Applicant Date
WI2'4Y,
All roof coverings to be Class'n' or better
Owner �atc -
or wuhorizcd agent