09040014C
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMrr NO.
21561 REGNART RD
REC SOLAR, INC. .
09040014
OWNER'S NAME:
PERMIT ISSUE DATE
.
S CONTROL NO.
(888)657-6527
ARCHITECT/ENGINEER:
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
in full [ores and effect.,
y
INSTALL SOLAR PV SYSTEM FLUSH MOUNTED TO ROOF
_ f O a
License Class
Dam Contractor G o
ARCHrrEGTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's Llccnse Law for the
following reason. (Section 7031.5, Business and Professions Cale: Any city ter county
which requires a permit to construct, alter, iimprove, demolish, or repair any structure
prior to its issuance. also requires Use applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) DiDivision 3 of the Business and Professions Code) or
14 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pwCty of
not momthan five hundred dollars (i50o)-
3 5 6 2 2 0 0 6.00
❑ L as owner of the property, or my employees with wages as their sole compensation.
Required Inspections
will do the wort, and the structure is not intended or offered for sale (Sec.70". Business
and Professions Code. The Contractors License law does not apply to an owner of
property wbo builds or improves therwn, and who does such wort himself or through his
own employcn, provided that sach improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will haw the burden of proving that he did not build or Improve for purpose of
ale.).
❑ L as owner of the property, sm exclusively contracting with licensed contracu= to
construct the project (Sec. 70". Business and Professions Code:) The Contraemrs Li-
cense law don not apply to an owner of property who builds or improves tbareon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the contractor's
License Law.
C]I am exempt under Sec. . B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affum under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compert-
saUon, as provided for by Section 3700 of the Labor Code, for the performance of the
wort for which this permit is issued.
ere and will maintain Workers Compensation Insurance, as mguired by Section
3700 of the Labor
,JCR1 133400
CERTIFICATE OF EXEMFnON FROM WORKERS'
COMPENSATION INSURANCE
(Thh section need not be completed if Ibe permit is for one hundred dollars (S 100)
or less)
I certify that in the performance of the work for which this permit is issued 1 shall not
eraploy any person in any manner so as to become subject to the Worked Compensation
LAWS of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of die Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
i hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Scc. 3097, Civ. C-)
Loaders Name
,
Lenders Address
I certify that 1 have read this application and state that the above Information is
'
correct. I agree uu comply with aft city and county ordinances and state laws relating to
building cons ruction, and hereby authorise representatives of this city to enter upon the
above -mentioned property far inspection purposes,
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabflitie; judgments, costa and expenses which may in any way accrue against said City
A PLIC consequence of D RSTANgranting S this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date �� .
SOURCE REGULATfQJ(
HAZAF(bOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the CerpeNno cicipal Code, Chapter 9.12, and the Health and Safety
Cade, S 25532(a)T
All roofs shall be inspected nor to an roofing material being installed.
P P• Y g g
❑Yea No
Yes
If a roof is installed without first obtaining an inspection, I agree to remove
VVIII the applicant err rot building oavpant use equipment or dcvicra which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Distritt7
❑ Yes o
`-
1 have read the hazardous materials mqub*ncrir• under Chapter 6,95 o[the Califor-
C�
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
7 O
does riot currently haw a tenant. Ural It is my raponsibi ity to notify the occupant of sire
J
requirements
All roof coverings to be Class'n" or better
Owner Date
or authery eras