BLD-2021-1930BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20179 NORTHWEST SQ Cupertino
APN: 316 39 049
PERMIT NO: BLD-2021-1930
OWNER'S NAME:
CONTRACTOR: SUNRUN INSTALLATION SERVICES INC, 225 BUSH STREET STE 1400 SAN FRANCISCO
CONTRACTOR PHONE:
DATE ISSUED 9/28/2021 2:15:47 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $7410.00
JOB DESCRIPTION
SYSTEM - (3.9 KW)
INSTALL 1 1-PANEL ROOF MOUNTED PV
LICENSED CONTRACTOR DECLARATION
C39 ROOFING
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
CI
LICENSED
EXP
06/30/2022
I hereby
force
I hereby
SUNRUN INSTALLATION SERVICES
CLASS:
ELECTRICAL, A GENERAL ENGINEERING,
NO: 750184
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
I certify that in the performance
laws of California. If,
with such provisions or this permit
INC
C46 SOLAR, B GENERAL BUILDING,
the provisions of Chapter
one of the following three
of consent to self -insure
Compensation Insurance,
of the work for which this
after making this certificate
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
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
the
have read the hazardous materials requirements under
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
will be responsible for this project.
Firm Certification No:
is required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm
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
representatives of this city
liabilities, judgements,
comply with all non -point
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
construction,
harmless
the applicant
Signature:
that I have read this application
and hereby authorize
the City of Cupertino against
understands and will
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.