B-2016-3181 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3191 "
10734 S STELLING RD CUPERTINO,CA 95014-4224(359 22 005) GREEN POWER
INSTALLERS INC
SANTA CRUZ,CA
95060
OWNER'S NAME: CHUANG CI3ANGSYANG AND YUNG HO DATE ISSUED:12/01/2016
OWNER'S PHONE:408-615-1558 PHONE NO:(408)615-1558
J,TCENSFD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lie.#952145
Contractor GREEN POWER INSTALLERS INC Date 09/30/2018 X BLDG _ELECT _PLUMB
_MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)18-PANEL ROOF MOUNTED PV SYSTEM(5.13 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.,
I-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:$18000.00
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: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 22 005 ,
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 applica understands and will comply with all non-point
source regulations per e C 9ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
/I f
—Signat.re /�Aippr
Date 12/1/2016 Issued by:Abby Ayende
it Date: 12/01/2016
OWNER-BUILDER 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. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/1/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS 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 MATERIALS DISCLOSURE
2. I 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
3. 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 Quail , anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain complia, ' , , 'ertino Muni ',. Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&':fety Code,Sec t i• ,s' 3 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agents
APPLICANT CERTIFICATION I_Date:12/1/2016 �
I certify that I have read this application and state that the above information is s 4' Lt. t
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. I understand my plans shall be used as public records.
Licensed
Signature Date 12/1/2016 Professional
t
ALTERNATIVE ENERGY PERMIT APPLICATION
,.. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONAE
,s 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
. 40 (408)777-3228• FAX(408)777-3333•buildinqCUPERTINOicupertino.orq VD (,,
-3tql
PROJECT ADDRESS !07.34f
3 �/`-� 5k lir✓ � 2 `)
APN# q- 7
OWNER NAME , a /� /
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STREET ADDRESS d CITY,STATE,ZIP ` ( FAX
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CONTACT NAME`t i' ( p� / (�,
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STREET ADDRESS ` )p+9 v- _ \\ CITY,STATE,ZIP �,�,/ FAX
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❑OWNER ❑ OWNER-BUILDER� D OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAMF ,v-� � ;� per,f4)+4)/T' LICENSE NUMBER 5R j j LICENN TYPI BUS.LIC# 2 �I
COMPANY NAME...r c.e p7r,je/r(t .544)p2i� E-MAIL FAX
STREET ADDRESS , pdtfic,kx' CITY,STATE,ZIP PHONE
ern
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC,t-
COMPANY
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 COmmerCial URBAN INTERFACE AREA 0 Yes 0 No FLOOD zoNE 0 Yes ❑' No
if SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: 'NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:ikAti) +
DESCRIPTION OF WORK J---` ]
J 1 3 k I g Fet,\•-e(c7It
RECENED BY� � w� T
By my signature below,I certify to each of the following: /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 provid-.d is cone have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build onstru io'. I authorize representatives of Cupertino to enter the above-ide ified prop I for inspection purposes.
Signature ofApplicanUenAgE - Date: f 1 /
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SUPPL OA NTAL INFORMATION REQUIRED
OFFICEUSEflNIY V:ta
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PVApp_2011.doc revised 03/16/11