08100196CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
10290 STERN AVE
REC SOLAR INC'
R'S NAME:
PERMIT ISSUE DAZE
PHO E:
A O. w w CONTROL NO.
(888)657-6527
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
LICENSED CONTRACfGR'S DECLARATION
Job Description
I hereby amrm that I m licensed under provision or Glapmr 9 (commencing
with Suction 70(MB or Division Sof the Business and Frofesdon Code. and my licenx is
in run Tone rM CR
SOLAR PV SYS FLUSH MNTD ON ROOF—PAINT TRIM TO
Llcanm Lk. M
Date Contractor
MATCH (E) ROOF.
ARCHITECTS DECLARATION
1 understand my plans adult W Isxd as Public records
Liccnmd Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors Licenx Law for the
following ,.,."e. (Section 7M 1.5, Business and Professor Cade: My city or county
which nNuirn a permit in corlslme4 alar, lmpm c, demolish, or repair my strumum
poor re, its issuance, also requires the applicant for such permit te file a signed samurai
Ft. Floor Area
Valuation
that he is llecaxJ pursuant to Om provisions; of the Conuutou's Linllx❑w(Chap=9
Sq.
(commencing with Some. 7000) 9 Didsion 3 of the Business and Ponessior Centelear
1417 0
this he is exempt clamminess and da: thou fur On alleged cas mptiun My violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for. permit subjects the applicant in a civil penalty of
not mom than Taw hundred dollars (S50(r).
37514035 .00
0 1. u owner of tit plvpcm. m my mploym with warm u Neo ole compemdon,
Required IDSpeCIIODs
will do the work, and tit u rottsmeded s, aliened fm a.ts (Sec. 7014, Husness
he Com . {tow don rot apply m rt rarer of
.rut m on Code The contractors
.
impmwachreon,andwho doesouchwork hivuelfor thrsale his
e ndwi
propertywhobailor
who
l intendedoroffemd far axles-
ownonu.
buiproHoedthmmonimpmwmmuarenot
however, Wearwdue or Ws t4manewithin ax yea or wpurew
of pre to,theownu-
Wilder will haw Ox When m proving that h did rod build r Impraw for purpox of
utas).
0 1, as owner of the property am exclusively contracd.& with licensed contraclon in
comma On project (Sec 7044, Business and Professions Code:) The Commuter's Li.
cane Law dors rot apply an an owner of property, who Wilds or impmws themer. and,
who mltracu for such pro cos with aconuamer(s) licensed purchases to the Conumam's
Liam Law.
I re exempt under See. . B A,P C for this moon
Data
WORKERS COMPENSATION DECLARATION
I hereby emote under Penalty of perjury one of the following decimation:
❑Ihawand will msnuinaCertifinu of Canxnuo xlf-Irurt fr WorkersCnnpen-
aadon, u provided for by section 3700 of We labor Code. for We perfmmame of the
work for which this permit is issued.
haw and will maintains Worka's Compensation IIISIIMa, n required by 5emlon
37110 of the labor Code, for the paformmcc of the work for which this permit is issued.
My Wo�am�`nuupv lnmrma cartiv and Policy upmyymmtu Y,7
.1 azz l a V� Policy No.: , 0 `
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu salon road not N completed i(the .it is fdrone hundred doll. (SIM)
or kms)
I cmtify that in the performance of the work for which this Permit is Wood. l shall am
employ any persue in my manner an as to become subject in We Wormer Gompar rtion
"wa of f.dllf miss Dale
Appllcanl
NOTICE TO APPLICANT: IL toner making this CeniRnle of Exemption. you should
become subject in We Wo l eri Compcasadon previsions of the IaWr Code, you mum
fmthwith comply with such provision or this permit sWll h doomed mvka.
1
CONSTRUCTION LENDING AGENCY
I hmhy.f ino that Were I.. conalmcdo.l adinr ageney forth performseua of
' the work for which this permit is issued (Ser. 3097, Civ, C.)
Lender's Name
,
lenders Addresa
I I anRy that I haw red this application ane mute that the show information is
cornL I agree so comply with all city and county ordlllNas and slam laws Ruling W
building construction, and hereby wthorim replesemmm of this city to enter upon the
abow-mentioned property, for Inspection purposes.
(We) agree in save, indemnify and keep hamlets tit City of Cupertino ag.I=
j Iiabilides,judgments, coati and a,. which may in any way acme igsrt saidCity
in con"fecrlce orthc grunting of this preemie
APPLICANT U DER ST AND 'PLY WITH ALL NON -POINT
Issued by: Date
SOURCER LMTI ,
Re -roofs
Type of Roof
S umof i m Dem
HAARDOUS MATERIALS DISCLOSURE
Will applat or future Wilding compact seem orsomatic huaNan mtomris
Med by Bre Cuper iro MunitaNu Chapter 9.11. ane de Health ane Safety
e. se 25s3z(,)7
All roofs shall be inspected prior to any roofing material being installed.
Yrs
❑y.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the apphcam or future Wilding occupant use, equipment or deices which
emit loosomn air co naresu do d by tit Bay Awa Air Qa ily Mmagcomm
all new materials for inspection.
Duuict7
OYn Nu
I have mad the haammu mamriaurequimmenu umlcr�tapmr6.95 ofdre Califor.
nts Healk Safely Cade. Scrams1 RS. 25533 and25534. 1 understood Waifthe Wilding
des rod currently, hoe . umne Ihu Il u m '"Et, in ratify de occupant of the
mgnincommawhi mine et r, ceninp.�ort3aap.rrry.
Signature of Applicant Date
(
All roof coverings to be Class'W' or better
Dam '
QW. mm tog