BLD-2020-1226BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 6387 MYRTLEWOOD DR Cupertino
APN: 369 17 005
PERMIT NO: BLD-2020-1226
CONTRACTOR:
SEMPER SOLARIS CONSTRUCTION INC, 1805 JOHN TOWERS AVE EL CAJON
CONTRACTOR PHONE:
DATE ISSUED 8/1 1 /2020 3:33:44 PM
ISSUED BY: haleym
VALUATION: $18826
JOB DESCRIPTION
MAIN PANEL (225 AMP).
(N) 12-PANEL ROOF MOUNTED PV SYSTEM - (4.14 KW); REPLACE
LICENSED CONTRACTOR DECLARATION
C20 WARM -AIR HEATING%2C VENTILATING AND AIR-CONDITIONING
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
SEMPER
LICENSED
B GENERAL
LICENSED
978152
EXP
10/31/2020
I hereby
force
I hereby
SOLARIS
CLASS:
BUILDING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
CONSTRUCTION INC
CONTRACTOR, C10 ELECTRICAL, C46 SOLAR, C39 ROOFING,
that I am licensed under the provisions of Chapter
under penatly of perjury one of the following three
will maintain a certificate of consent to self -insure
this permit is issued.
will maintain Worker's Compensation Insurance,
in the performance of the work for which this permit
laws of California. If, after making this certificate
such provisions or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
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 construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application and state that the above
construction, and hereby authorize representatives of this city to
harmless the City of Cupertino against liabilities, judgements, costs,
the applicant understands and will comply with all non -point source
Signature:
/\/
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.