B-2016-2240 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2240
10390 OAKVILLE AVE CUPERTINO,CA 95014-4573(369 13 013) SUNWORK
RENEWABLE ENERGY
PROJECTS
MILPITAS,CA 95035
OWNER'S NAME: LEE WING CHEUNG AND NI JUN DATE IS SUED:06/29/2016
OWNER'S PHONE:408-881-4084 PHONE :(650)520-9918
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:'
License Class SOLAR Lic.#920732
Contractor SUNWORK RENEWABLE ENERGY PROJECTS Date 08/31/2016 X BLDG _ELECT _PLUM I
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_ OMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations; (N)12 PANEL ROOF-MOUNTI D PV SYSTEM(3,36 KW)
1. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
1�J,2( 1 have.and will maintain Worker's Compensation Insurance,as provided for by
//� Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$9400.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupan y Type:
and state laws relating to building construction,and hereby authorize 369 13 013
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES WORK IS N4 T STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 18Q DAYS F PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature %� �, 2 Date 6/29/2016 Issued by:AbbyAyende
Date:06/29/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the R
OOFS-
following two reasons: All roofs shall be inspected prior to my roofing material be g installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an in pection,I agree to rem ve all new materials for
compensation,will do the work,and the structure is not intended or offered for pection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/29/2016
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERING 3 TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent,to self:insure for Worker's -
Compensation,as provided for by Section 3700.of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS ATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Cod D,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cup orting Municipal Cod ,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 2 5532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I us equipment or device which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the upertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod ,Sections 25505,255 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. i .Owner or authorized agent: A>
APPLICANT CERTIFICATION V Date:6/29/2016
I certify that 1 have read this application and state that the above information is ST LENDING A E Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a con,truction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is lE sued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands ,
and will comply with all non-point source regulations per the Cupertino Municipal ARC TEITISDECLARATIOTN
Code,Section 9.18. I understand my plans shall be us d as public records.
Licensed
Signature Date 6/29/2016 Professional