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B-2016-2555 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2555 10290 BONNY DR CUPERTINO,CA 95014-2906(359 11 037) SUNPOWER CORPORATION SYSTEMS SAN JOSE,CA 95134 OWNER'S NAME: THAM TERRY KINGSENG AND CHID SUET MUI DATE ISSUED:08/19/2016 OWNER'S PHONE:408-218-3775 40:(941)72,0-3850 L I NFD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL ENGINEERING CONTRACTOR Lic.#890895 Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2017 X BLDG —ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECH X RESIDENTIAL_COMMERCIAL 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)13-PANEL ROOF MOUNTED PV SYSTEM(4.36 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. 2.`f1 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:$22000.00 APPLICANT CERTIFICATION 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: Occupancy Type: and state laws relating to building construction,and hereby authorize 359 11 037 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 IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ISO DAYS FROM LAST CALLED INSPECTION. K' A Signature Date 8/19/2016 Issued by:AbbyAyende Date:08/19/2016 OWNER-BUILD R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being 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 inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:i contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOFCOVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS 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 Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,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 25532(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 use equipment or devices 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ,j r N be deemed revoked Owner or�/a2utth6orized agent: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is CONSTRUCTION 64ING A EN KY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(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 ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 8/19/2016 professional ALTERNATIVE ENERGY PERMIT APPLICATION -' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION - 10300 TORRE,AVENUE CUPERTINO,CA,95014-3255, CUPERTINt3 (408)777-3228•FAX(408)777-3333•building@cupertino.org PROJECT ADDRESS j®� EON "t1V s n APN# y V �J i OWNER NAME 13U 1 ' '` , (� PHONE'Je p(� �s 1' � E MAII I p� STREET ADDRESS (�. ®C� t�lvll�� `I [�' 6T 1 N y CITY,STATE ZIP�U PG l�Tldi/� C A �t 5 o f FAX y\q CONTACT NAME V PHONE a g" E-MALI 'Jf+�eai ©LJ�CwC oi�rr Gini STREETADDRESSa 16 ��1 � f�I ICITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT IdCONTRACTOR g(IONTRACTORAGENT ❑ ARCHITECT '0 ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# 3 9'C4 p s �r ACi;Z.eq J l _I"`3 COMPANY NAME 1�7�ic1J G f �lam[C�i�p �pV E-MAIL FAX STREET ADDRESSr CITY,STATE,ZIP PHONE ARCHITECUENGINEER NAME LICENSE NUMBER ►,A'N. � PL" Bus.LIC# COMPANYNAME 5,-tj Pi;��I\ cot el ,71,J E-MAIL � �O�,�vPZ �pl FAX STREET ADDRESS .7-7 �J 6 E7S CITY,STATE,ZIP S ir C11 9 PHONE �A o S g ®�a USE OF �SFD Or Duplex 0 Multi-Family PROJECT IN WILDLANn '1 PROJECT IN L t STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes Q. NO dSOLAR PANELS ❑ ELECTRIC VEHICLE.CHARGING STATION ❑ SOLAR WATER HEATING " ❑ OTHER FOIL SOLAR PANELS: NUMBER OF PANELS/UNITS: — KILOWATTS(COMMERCIAL ONLY): TOTALVALUATION- g- 4 DESCRIPTION OF WORK P®,� Tie?) 4 6'STEM Eo'I RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree tocomply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified prope or"inspection purposes. Signature of ApphcanVAgent: Date: " t ei j 6 SUPPLEXM TAL INFO TION REQUIRED OFFICE USE ONLY ❑ OVER-TH&COUNTER. ❑ EXPRESS ` ❑ STANDARD " U ❑ LARGE a .MAJOR PVApp 2011.doc revised 03116111