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BLD-2020-1622BUILDING PERMIT CUPERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: 21870 ALMADEN AVE Cupertino APN: 357 15 109 PERMIT NO: BLD-2020-1622 OWNER'S NAME: LIN JASON JIANHORNG TRUSTEE & ET AL OWNER'S PHONE: (213) 200-1975 JOB DESCRIPTION STORAGE SYSTEM - (27 KW); (N) LOAD CENTER -( 200 AMP) (N) 12-PANEL ROOF MOUNTED PV SYSTEM - (4.08 KW); (2) ENERGY LICENSED CONTRACTOR DECLARATION ROOFING, C36 PLUMBING 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 12/31/2020 I hereby force I hereby CLASS: SOLAR, B GENERAL NO: 888104 DATE: affirm and effect. affirm I have and for which I have and I certify that with TESLA ENERGY OPERATIONS INC BUILDING CONTRACTOR, C10 ELECTRICAL, C39 that I am licensed under the provisions of Chapter under penatiy of perjury one of the following 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 laws of California. If, after making this certificate such provisions or this permit shall be deemed revoked. three 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 permit 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 Chapter 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 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 as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Sections 25505, 25533, and 25534. or devices which emit hazardous air contaminants Code, Chapter 9.12 and the Health & Safety Code, EPA LEAD -SAFE DISCLOSURE for this project. Firm Certification No: An EPA Lead -Safe Certified Renovator will be responsible 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 to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, source 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 harmless the City of Cupertino against liabilities, judgements, the applicant understands and will comply with all non -point Signature: .