08120032 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION ;
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BUILDING ADDRESS: PERMIT NO.
10725 ORLINE CT REC SOLAR INC-
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OW
NER'S NAME: PERMIT ISSUE DATE
TEp SA CONTROL NO.
ARCHnECT/FJVGINEER:
BUILDING PERMIT INFO
SOLAR PV SYSTEM FLUSH BLDG MEcx
ELECT ?Cultic
am, CONTRACTOR'S DECLARATION MOUNTED ON ROOF
wF 1 Mrcby affirm Nal 1 am licensed under provisions of Chapter 9(commencing lob Description
�Zul wide section 7010)of Division 3ofthe Busincus aM Profession Code,and my license is
ja^i❑ in full fovnd g t
emc_L'm.
GonuaOe O
a CDam • ,
ZZ 7W7W ARCHrECrS DECLARATION
C I unimmand my plans shall h=it as public meet&
JyU
g0: Licensed Professional
iyx OatIam exempt
UILOER mptfrm Ce ConarON
COO F 1 hrtby,.(sero dem 11. .Burin from the l o omml Co L cense Law for Irk
p O following mason.(Suction 7(D I.S Business and vo. un Code:Any oily or county
j$ which its ism a permit re cores the alley,improve,h permitdemolish,or repair any structure
Z< poor w i6 censed pursuant le the thovisio s o for such permit icensile ae sew(Cha roam
that
ommtsranad pursuant n)of Division
oftheBusiwr,nd Prid ionC Code)
Sq.F[. Floor Area Valuation
L�$ that he smeampth Section]000)Of Divisionl nfdec licit wand Professions Ction or
of
this h u exempt thrUrom and Irk buts for Irk alleged exemption Any violation of
Sccdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Ihan five hundred dollars($500).
❑L os owkr .and
pmputcton my wmmided who wages ss ale(Sm.compensation,
and do dee wort and tie he Con Is ides License
or sew oc far sale(Sm.7014.Business
noof
and property
who
Code Th Cenoacwh Ld who Law does not apply lf rt owner or Required Inspections
propem who s,priemirePhat such Ih improvements
and who doessuchwork ornament
through his
eve event ebuilding
uidngorithatsuch improvementsartnotinn,Medmpletied foe We.If.
however,the buil ding orimprovemerntssoldwithinoneyear of cprove for
the Poo of
builder will have Irk burden of proving Nat h did not build Or improve for puapou of
❑I.as Owner of the Property.am exclusively convicting with licensed aentrame as b
coeswci the project(see.7014.Bualnese and Professions Code:)The Convaemh Li-
cense Law dots not apply tu an Owner or property,who builds or improves thereon.ad.
who contracts for such projects with a cominucroo(s)licensed punuam wee Cuumaclora
License Law.
❑l and mempt under see. ,B B P C for this mason
ownv Dan,
WORKERS COMPENSATION DECLARATION
I bcscby affirm under perWly of perjury One of the following dimlaadonc
❑I ham and will mainain a Certificsn,of C...t m aeif-insure forwarkchCompm-
sation,as provided for by Section 3700 of de Labor Code,for the Performance Of the
work for which this permit is issued
1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the Labs Code,far the performance ofthe,work for which this permit us issued.
My Wm h�C(e�m�pfe�mfioonn Insurance cartien and Policyr � 3JIfJ�3
Cartier.\�ct't'1c/3(fSh Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lima section reed Out had completed if the pcemit is fmonc hundred dollars(5100) _
M hiss)
I cenify that in Ne ficip omim of the work for which this permit is Tuned,I shall out
employ any person in any manner an as b become abject to tie Workers Compensation
Laws of Caliromm Date
Applicant
NOTICE TO APPLICANT:If.after making this CcnlBom of Exemption,you should
become subject in the Workurs Compcnsition provisions of the labor Cmc,you in=
z faMwith comply with such prevismos Or this permit shall h deemed revoked.
z O CONSTRUCTION LENDING AGENCY
'ra 4 1 bcmby aRom that them is a cOttseuctinn lending agcucy for the pereomana of
rL > the work for which this Permit 4 Lattice(Sec.3097,Civ.C.) -
1<ndersName
z Lenders Address
U p 1 certify that 1 have mad this application and sue that the above information is
M H correct.1 agree in comply with all city and county andinancm and sate laws relating 10
.0 U building construction,and hereby autborine mpensenutives ofthis city to enter upon the
r t2j above-mentioned property for inupeNon Purposes.
f—'y (We)agree to ave,indemnify and trop harmless tie City or Cuperum against
fp liabiliticajudgmcnts,costs and expenses which may in any way acnueagalmet said City
U Z APPs parmil.
L CANTOgraming of I
UN of
RSTANDS A
IN!'WILL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RFs /0
�i Re-roofs
Sigrutum ser AppG 44AADam
ZARR000S MATERIALS DISCLOSURE Type of Roof
Will the applicant or future holding occupant4wm or handle havudous mamdal
as de0ned by tie Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cede.Beeden 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes40 a
Will the applicant or future Wiliingoccupant=equipmenEa devices which If a roof is installed without first obtaining an inspection,I agree to remove
emil havaNnus air contaminants u defined by the Ray Asea Air Quality Management all new materials for inspection.
District? —_
❑Yes �N
I have mail do,hvardws man,riala"torements tinder Chap orb.95 of the Califor.
nia Health&SafctyCode,Savau 25505.25533 and 25534.1urknstsnd thmifde building
does On cuncnJY hove a moans that it u m ility w ratify dm occupant of de
rtgmrtmenu wH h prierm' aceatirean,ser 0" q. Signature of Applicant Date
of
own eratime zed as Dam All roof coverings to be Class'%¢!'or better