BLD-2020-0382BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10235 VICKSBURG DR Cupertino
APN: 369 07 011
PERMIT NO: BLD-2020-0382
CONTRACTOR:
LA SOLAR GROUP INC, 16238 RAYMER ST UNIT B VAN NUYS
CONTRACTOR PHONE:
DATE ISSUED 2/27/2020 10:49:51 AM
ISSUED BY: HALEYM
VALUATION: $24000
JOB DESCRIPTION
ROOF MOUNTED PV SYSTEM (7.705 kW)
INSTALL (N) 23-PANEL
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LA SOLAR
LICENSED
C10
LICENSED
974115
EXP
06/30/2020
I hereby
force
I hereby
GROUP INC
CLASS:
ELECTRICAL, C46 SOLAR, C39 ROOFING
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent to
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which
laws of California. If, after making this certificate
with such provisions or this permit shall be deemed
three declarations:
self -insure for Worker's
as provided
this permit is issued,
of exemption,
revoked.
Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I shall not employ any person in any manner so as to become subject to the Worker's
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter 6.95
the Health & Safety
as defined
Code, Sections 25505,
for this project.
project.
of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12 and
V
with
equipment
Municipal
Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25533, and 25534.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this
Certified
v
CONSTRUCTION LENDING AGENCY
construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a
No
V
Lender's
Name:
APPLICATION CERTIFICATION
the above information
this city to enter upon
costs, and expenses
-point source regulations
is correct. I agree to comply with all city and county ordinances and state laws relating to building
the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
which may accrue against said City in consequence of the granting of this permit. Additionally,
per the Cupertino Municipal Code, Section 9.18.
I certify that I
construction,
harmless the
the applicant
.,
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.