BLD-2020-215512/21/2020
CITY OF CUPERTINO BUILDING PERMIT
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 18820 ARATA WAY Cupertino
APN: 375 13 010
PERMIT NO: BLD-2020-2155
OWNER'S NAME: SF19G LLC
OWNER'S PHONE: 949-481-7026
CONTRACTOR: JAJ ROOFING, 4980 ALLISON PARKWAY VACAVILLE
CONTRACTOR PHONE:
DATE ISSUED 12/21/2020 4:59:53 PM
ISSUED BY: haleym
VALUATION: $18000
JOB DESCRIPTION
INSTALL (18) PANELS ROOF MOUNTED SOLAR SYSTEM (5.58 KW)
LICENSED CONTRACTOR DECLARATION
LICENSED NO: 647149 EXP DATE:
07/31/2021
7000) of Division 3 of the Business & Professions Code and that my license is in full force
CONTRACTOR:
I hereby
and
I hereby
affirm
effect.
affirm
I have and
this permit
have and
I certify
permit shall
JAJ ROOFING LICENSED CLASS:
B GENERAL BUILDING COI
that I am licensed under the provisions of Chapter 9 (commencing with Section
under penalty of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's Compensation,
is issued.
will maintain Worker's Compensation Insurance, as provided for by Section
that in the performance of the work for which this permit is issued, I shall not employ
If, after making this certificate of exemption, I become subject to the Worker's
be deemed revoked.
as provided for by Section 3700 of the Labor Code, for the performance of the work for
which
3700 of the Labor Code, for the performance of the work for which this permit is issued.
any person in any manner so as to become subject to the Worker's Compensation laws
Compensation provisions of the Labor Code, I must forthwith comply with such provisions or
of California.
this
HAZARDOUS MATERIALS DISCLOSURE
Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the
I have read
Municipal
the hazardous materials requirements under Chapter 6.95 of the California
Cupertino
Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a)
should I store or handle hazardous material. Additionally, should I use equipment or devices
District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
which emit hazardous air contaminants as defined by the Bay Area Air Quality Management
the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
r 1
Firm Certification No: I 1
L J
An EPA Lead -Safe Certified Renovator will be responsible for this project.
r 1
Firm Name: [ 1
L J
No EPA Lead -Safe Certified Firm is required for this project.
Certified
CONSTRUCTION LENDING AGENCY
performance of the work which this permit is issued (Section 3097, Civil Code).
r 1
Lender's Address: [ 1
L J
I hereby
affirm
under penalty of perjury that there is a construction lending agency for the
No
r 1
[ 1
L J
�Yes
Lender's
Name:
APPLICATION CERTIFICATION
agree to comply with all city and county
property for inspection purposes.
against said City in consequence
Code, Section 9.18.
ordinances and state laws relating to building
(We) agree to save indemnify and keep harmless
of the granting of this permit. Additionally, the applicant
I certify that I
construction,
the City of Cupertino
understands
Signature:
nyvtee4scv
have read this application and state that the above information is correct. I
and hereby authorize representatives of this city to enter upon the above mentioned
against liabilities, judgements, costs, and expenses which may accrue
and will comply with all non -point source regulations per the Cupertino Municipal
N
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.
,
Submit
https://apps.cupertino.org/Accela/BLD-Sign-Permit.aspx?AccelaUser=ONETIMESIGN&OTK=edNwjLYICbmyaMVs6zQ6gVo5LgOdDLyj03RzTFkRLUZ... 1/1