08040111CITY OF CUPERTINO
PERNIIT
BUILDING DIVISION
BUILDING ADDRESS:
PERMfr NO.
10136 CAMINO VISTA DR
SOLARCITY
08040111
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SANrrARY NO. CONTROL NO.
ARCHrrECr/ENGiNEER:
BUILDING PERMIT INFO
INSTALL FLUSH ROOF MOUNTED
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
ob_Descrlption
I hereby affirm that I am licaased under provisions of Chapter 9 (commencing
^- - .. . _, .-. ,
with Section 700M of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License aria Lk. r
Date _141 504212r Contractor
ARCHr1ECf-S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following, reason (Section 70315, Business and Professions Code: Anycity or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Conuctoes License Law (Chapter 9
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Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alit exemption. Any violation of
APN Number
Occupancy
Pane Y Type
Section 7031-5 by any applicant for a permit subjects the appllanl to a civil penalty of
not more than five hundred dollars (SSWo
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: TTte Contractors Licetue Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
row employees, provided that such improvements ate not intended or offered for aale. If,
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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.).
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❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:)The Conttaciors L-
eone Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec. , B & P C for this mason
Owner Date
WORKER'S COMPENSATTON DECLARATION
1 hereby affirm under penalty of perjury one of the following declaalionc
❑ 1 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 Insunntce, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My
— Policy No.. �7 oak i a�
FICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
.
(ILis section Treed not be completed if the permit Is for one hundred dollars (S1OD)
or less)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Winters' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Coda you mast
forthwith comply with such Provisions or this pewniL shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby afrrrm the there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders Name
Lenders Address
1 certify that I have read this application and state that the above information is
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correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize mpresenatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way acme against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued /J �i [1-3vim
I Date
HAZARDOUS MATDUALS DISCLOSURE
Will the applicant or future building occupant sloe or handle hamrdous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section 25532(a)T
❑Ya p(No
All roofs shall be inspected prior to any roofing material being installed.
T�
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contan inants as delincd by the Bay Area Air Quality Management
all new materials for inspection.
Distria7
❑Yes AN.
I have mad the hazardous materials egaimmcns under Chapter 6.95 of the Califor-
nia Health & Safety Coder, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
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or authorized agent am