09060014 CITY OF CUPERTINO
BUILDING DIVISION PERMITS ► � �' � + :
BUILDING ADDRESS: PERMIT NO.
21091 TULITA CT REGRID POWER
PERMIT ISSUE DATE
OWNER'S NAME:
SWAYA,
CONTROL NO.
.
(408) 927-0811
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLLX'i ELECT PLUMB MECH
v p p LICENSED CONTRACTOR'S DECLARATION Job Description
ro I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=, in full force andectC INSTL PHOTOVOLTAIC (SOLAR) ON RES ROOF
cen
Z LI Ise ClC1au ` LIC.
k
t p Datc 1 Contractor
/ ARCHTTECTSDECLARATI014
I understand my plans shall be used as public records
X96
rO H Licensed Professional
03 OWNER-BUILDER DECLARATION
ZI hereby affirm that 1 am exempt from the Contractor's License Law for the o O following mason.(Section 7031.5,Business and Professions Code:Any city or county
y3 0! which requires a permit to construct,alter,improve,demolish,or repair any structure
14 prior to its issuance,also requires the applicant for such permit to file a signed statement
z< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7 3 2 2 9
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 32628069 . 00
❑I,as owner of the property,or my employees with wages as their solo compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such 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 have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's L.i-
ccnse Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sea .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the labor Code.for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My WorkeesL,sCompgmation Insurance carrier and Policy number amp:
Carrier.2V,2 Ledo Policy No.;0110 Cd (?8712I
QERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
vJ O forthwith comply with such provisions or this permit shall be deemed revoked.
z"4 CONSTRUCTION LENDING AGENCY
(~i I hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
az L.entices Address
(�O I certify that I have read this application and state that the above information is
W*[" I agree to comply with all city and county ordinances and state laws relating to
C)Ubuilding construction,and hereby authorim representatives of this city to enter upon the
W above-mcntioned property for inspection purposes
GL (We)agree to save,indemnify and keep harmless the City of Cupertino against
rF-t liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date J �`
t"c APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued
signaiure ofAirpticaftlCtFaLractor —7 bate Type of]Roof
HAZARDOUS MATERIALS DISCLOSUREc
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
fi
❑Yes ItNe
Will a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Yes am
I have read the hvardars materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code.Sections]5505,25533 and 25534.1 undcrstmrd that if the building
does not currently have a tenant.that it is my responsibility to notify the occupant of the
requimn5
are