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CITY OF CUPERTINO
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BUILDING DIVISION
PERMIT
BUILDINM�nDRESS:
PERMrr NO.
27.324 CARTA BLANCA ST
SOLARCITY
08080126
SANITARY NO- CONTROL NO.
ARCHiTECUENGINEPR:
BUILDING PERMIrnYFO
4.1KW ROOF MOUNTED FLSH
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 Dtvision 3 of tbo Business and Professions Code. and my license Is
in full force and feat- �' O 44
I icenee Clue C' 4 (o C i O Lie. n
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shill be used a public records
Licensed Professional
OWNER-BUr DER DECLARATION
I hereby affirm that 1 am exempt from the Contramoes License Law for the
following reasson. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alley, improve, demolish, or =pair any structure
prior to its issuance, also requires the applicant for such permit to file a signed staiemertl
mat he I, licensed pursuant to lha provisions of the Contracters Lmnsc Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 or the Business and Professions Code) or
tlat be is exempt therefrom and the basis for the alleged ewaptioa Any violation of
APN Number
Occupancy
P �
Section 7031-5 by arty applicant for a permit subjects the applicant to a Civil penalty of
not momThan five hundred dollars ($M
❑ L as owner or the property, or my employed with wages as their Sole compensation,
Required Inspections
will do the worts. and the aouclme Is not intended or offered for sak (Sec. 7044. Business
and Professions Cotle: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himsrJrm though bier
own employees, provided that such improvements are not Intended or offered for air. If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, n owner of the property, am exclusively contracting with licensed contractors to
wnatrom the project (Sec. 7044, Business and Professions code:) The Contractors Li.
sense Law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a conlymo*) lionised pursuant to the Contractors
L hnr Law_
'
❑ 1 am exempr tinder See. . B h P C for this town
owner Due
WORKER'S COMPENSATION DECLARATION
I hereby +Rims under penally of perjury oto of the following declarations
I have and will maintain a Certificate of Consent to self-hurme for Worirds Canpeo-
sedan, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued-
1 have and will maintain Worts Compensation IRAtrance, u required by Section
or the Labor Code, for the performance of the work for which this permit is ianied.
My Workers Compensation Insurance artier and Policy number a=:
Carrier. ern Af Policy N40P_Cs7_C I a
WORKERS'
01
C1$nFICATE OF DMMFrION FROM
COMPENSATION INSURANCE
(This section need not too completed if the permit Is for onnc hundred dollars (3100)
.
or lest)
I Certify that in the performance of the work for which this permit to issued. 1 shall not
.
employ any person in any manse u_b heeama aubiect to the Workcri Compensation
%W_
Laws; of Cali�qrpr�. Dn�m �,r
Applicant ter,% ► L) 77 1 Q
— —
NOTICE TO APPLICANT. If. after making this Ctnifin= of Exemption, you should
become subject to the Workers Compensation provisions of the 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 (See. 3097, Civ. C.)
Lerdcn's Name
,
Lender's Address
1 certify that 1 have read this application and state that the above information Is
_
cored. I agree to comply with all city and county, ordinances and state laws relaiing to
building construction, and hereby wthoria representatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City or Cupertino against
liabilities, judgments. cow and expenses which may in any way accrue agaist sad City
in consequence of the granting of Oda permi4
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
signature or Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
WIN the applicant or future balding ottvpaut sore or handle hazardous macaw
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Ayes 25532(')?
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
W01 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 materials for inspection.
District?
❑ Yea �No
smaterials
ueriilsrequirements
IhcenetnChapter G9Califor-
nix Halm& SafctyCode Scctions2SSOS.25533e2353.4.iwdentsndtuLifLhc building
,
does rot currently have a newest. that it is my responsibility to mKify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
_
Signature of Applicant - Date
All roof coverings to be Class'V' or better
owner Date
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