BLD-2020-1554BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10948 SYCAMORE DR Cupertino
APN: 342 56 035
PERMIT NO: BLD-2020-1554
CONTRACTOR: H C I SOLAR, 2121 N CALIFORNIA BLVD #290 WALNUT CREEK
CONTRACTOR PHONE:
DATE ISSUED 9/28/2020 12:22:51 PM
ISSUED BY: PhuongD
VALUATION: $34931
JOB DESCRIPTION
- (12.045 KW)
(N) 33-PANEL ROOF MOUNTED PV SYSTEM
LICENSED CONTRACTOR DECLARATION
the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C46
LICENSED
EXP
02/28/2021
I hereby
force
I hereby
H C I SOLAR
CLASS:
SOLAR
NO: 1024165
DATE:
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of
laws of California. If, after
with such provisions or this permit
one of the following three declarations:
of consent to self -insure for Worker's
Insurance, as provided for
the work for which this permit is issued,
making this certificate of exemption,
shall be deemed revoked.
Compensation, as provided for by Section 3700 of the Labor Co lie, for the performance of the
work
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
requirements under
9.12 and the Health
Chapter 6.95 of
& Safety Code,
as defined by the
Sections 25505,
the California Health & Safety Code. Sections 25505, 25533. and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
Section 25532(a) should I store or handle hazardous material. Additionally, should I use
Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is
Certified
v
CONSTRUCTION LENDING AGENCY
that there is a 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
of this city
judgements, costs,
with all non -point source
information
to enter upon the
and expenses
regulations
-
.