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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CON TRACTOWINk GRMATI0N,
BUILDING ADDRESS:
PERMIT NO.
21.410 VAI AVE
SOLARCITY
08070094
HER'S NAME:
PERMrr ISSUE DATE
NAGARAJ MURTHY
393 VINTAGE PARK DR STE 140
07/23/2008
PHONE:
SANITARY NO. CONTROL NO.
(650) 638-1038
ARCHrr9CrfENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LICENSED CON'TRACTOR'S DECLARATION
CWpm 9
Job Description
armor (ummuciy
1 hvcbY affirm Net 1 w Ii¢tttW under pmsvio. of
p
viN Srotion]OOU)ofD,..alof the Bud. and Prnfotdo. Cade. and my license u
4.92KW RF FLUSH MNT PHOTOVOLTAIC SYSTEM
infullfom and mLC'C'10 Lk., _r
Dam ControoarlJ /
ARCHRDECLARATION
1 understand my plans shall
mun1 bo mud an WM1lie massa
Lmc.ed Pmfeatonal
OWNER -BUILDER DECLARATION
I hereby affirm that I am commit, from the Convenors Uccnw Law far the
following Macau. (Section 70113, Buiomas and Profeada. Cade: My city at county
which m4uim a permit to cmumuc6 shm, impmse, demolish, or mpalr any summon.
prior ut its issuance, sous mquires Ne applicant fmsmh pumit to file asignad.=Cut
that he is licensed pursuant to tux provisions of the Cantrstars ucemm law(Chapmr 9
Sq. Ft. Floor Area
Valuation
(commencing with SMion 7000) of Division 1 of the Busm•• and Pmfesdo. Cade) v
$25000
that he u exempt Nmcfram and the basis for W allegro eremptiom My violation of
A,ryI�t Number
36205023
Occupancy
P Y Type
Smdon ]011.5 by try applicants for apermit mbjccu W applicant' m a civil pwluy Of
antramadanfivehurldreddn"no,(S500).
.'VV'
❑ 1, a owner of Ne propmry. m mY unplayen with cages u Ne"vmk compcwtion,
wi0 dofewort. and W swouahna's Lictcdm ave door
and amar of
Cade: The Law dao not apply lf an owner err
theram,
Required Inspections
and who dmasmh work his
property who builds m improves Ih and
arty wh bis vas who
ownthat such impmsem moffe dWaugh
imiu not inmMdaroRead for ale If.
ons. the within theowner.
buldar Wbuildingerr improvement 4hat within aneuld of cemoac
builder will have the burden of paving dist he did rot bWld or improve for purport of
for of
_
sale.).
❑ 1. u owar of the property, not estludvmly eonuscsing with licensed eanhmmrs to
cauttm do projco (Sec. 10th, Buainea rad Profetda. Code:) The Coavaemrs Li-
cen•, Law dors act apply to an ow.r of property, who builds or improves theaon, and,
who contracts fou such aojnv with a eonuxwr(s) Iiutsmd pmuuat m We Conurmors
-
LsenmLaw.
❑ lunvemp,undm Sen ,BkPCfor Ws.san
m Date
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under facility of perjury am of the fallowing declarations:
❑ INwond will malnuinaCenifium of Consemmalf-i.uM fm Womkm's Campers-
.provided for Satian 1]00 of W labor Code. Ice W porfomart¢ of W
wm*f
wort for which this Pamir is issued.
kI Nve and will maintain Workers Commandos Insurance, u requiad by Section
of W Labor Code. for do, pndom,rcaoftlx wort for whim this N it u lssmd
My rke, Compounds. sura curia and Policy yyt¢g(ap�rt�O 1'
Grier tG Policy Na.:
n
CERUFICAM OF IDEMPnON FROM WORKERS'
COMPENSATION INSURANCE
Crbis sm9on rcrd our W cmnpkmd if the pc mm Is foram hundtrddoBota (SIM)
or lest)
I anify that in the performance of W work fm which this permi, is Woad. l shall not
employ any person in any man.rm as m hexame subjmt to the Workers Compwation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become mbjccs m W Workm', Co.N.Uon povso. a the Lab. Code, you mail
forthwith comply with smut proviso. or this permit shall bo damcd mvked.
CONSTRUCTION LENDING AGENCY
I hmeby office this Wm h a cenwunion knding ogenry fm tux perfomume or
Ne wort for whim Ws patch is imuW (Sec. 1097, Ci, C.)
L.caders Name
Undees Addmss
1 cannily that 1 have mad this application and cum that W above information is
c0mocL I gone in comply with all city and county oNi.nac and snm laws miming m
building construction, and hemby authooire.prvenudwt of this city in cnmr upon W
above-mentioned property for impaction purposes.
(We) Al to ave, indemnify, and kap harmless W City of Cupertino against
liabilities, judgmcm, case and espcmns which may in my way+ernc against said City
in consequence of W ifanting of this permk
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date .7 • 2 7'`�
SOURS5��REGUUTIONS.
t5- lI[ iA)C(_nA-7lr�;)lnO
Re -roofs
Signuurc of ApplicantOo tuactor on
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant err rmore hwlding amvp.t oma m hrMk hmardo. mamriJ
as defined by W Cupertino Municipal Cc&. Chapmr 9.11, and W Health and Safvy
. Sc 25532(x)7
❑Y. �t No
Yes
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or futum building occupant um equipment or dcvim which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hmandous air conumi.mu as unload by W Bay Amo Air Quality Managcomm
all new materials for inspection.
District?
❑Yes A(Nu
I lam read W hanmous manruls.quircmau underchapter6.95 of W Califor-
nuHeslthASafayCode, Sm6mu25505.25511" 25514.1understand Wtifthe building
dons rot cmmmy how a crane that i, h my mponshility m rotifY the occupant of the
gjuve c arcus ,m �r.cmdr,maraapamy.
der LV j HCl 7�r1c7 iCYI
Signature of Applicant Date
All roof coverings to be Class'1{" or better
Owner or auNamtd agent part ' '