B-2017-0587CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0587
11057 FLOWERING PEAR DR CUPERTINO, CA 95014-0492 (323 45 039)
SUNRUN
INSTALLATION
SERVICES INC
SAN LUIS OBISPO, CA
93401
OWNER'S NAME: OLSSON FREDRIK K AND JEANETTE
DATE ISSUED: 04/13/2017
OWNER'S PHONE: 408-799-5976
PHONE NO: (415) 580-6900
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-46 Lic. #750184
Contractor SUNRUN INSTALLATION SERVICES INC Date 06/30/2018
X BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL COnEMRCIAL
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) 10-PANEL ROOF MOUNTED PV SYSTEM (2.9 KW); (I) SUB
I hereby affirm under penalty of perjury one of the following two declarations:
PANEL (125 AMP)
t. 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.
/f 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
Sq. Ft Floor Area:
Valuation: $5829.00
permit is issued.
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
323 45 039
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 ertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 4/13/2017
Issued by: AbbyAygnde
Date: 04/13/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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 Cade).
Date: 4/13/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
m. 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code,SSe do , 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. --
Owner-or authorized agent:
APPLICANT CERTIFICATION
Date: 4/13/2017
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construcX0911ending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issu Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender°s Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
A'S
ARCHITECT'S
and will comply with all non-point source regulations per the Cupertino Municipal
.RATION
I understand my plans shhallall bbe used as public records.
Code, Section 9.18.
Licensed
Signature 'Date 4/13/2017
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ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT OEEPARTIMIENIT_ - BUILLDING DIV210M.
1(=0 TORRE AVENUE - CUPERTINO, CA 95014-32�5 A
(405) 77-1-322B - FAX (408) 777-3333 - buM;Hn!;ftAp.P_rthqorq
PROSECT AnDRMS 11057 Flowering Pear Drive
APN 9 32345039
owvNiaYn Fredrick Olsson MCNE (408) 799-5976 H-MATL fredrik—olsson@yahoo.com
STREET ADDRESS 11057 Flowering Pear Drive COY"STAT W Cupertino, CA 95014 FAX
EC.N'TACT NA -ME Vance Jason (408) 506-3693_. vance.jason@sunrunhome.com
Same as Contractor MY. STAT4 ZIP
0%&N -MA 0WWMZVHZM EJ VA -M-5. AGENT VCOMIRACMIL ARCHaTEM SN'=- R 0 DEVELORER 0 TEN"r
Sunrun
E4c: w""n 750184 ltcE3s rr^rttC-46
Etl�-"t_' 27932
COMPANY NAME
Sunrun
Est ASA
FAX (408) 894-9294
STURTA1313KRES 575 Dado Street
f, STATZ ZIP Sa n Jose, CA 95131
PHONE (408) 747-2487
NAME
LICENSIE NUMUR
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FORSMARPAIN W -R, NIUMEROPM34-2-I&IMNIM 10 ow mg (CM%&tPRcrALdN;_14z
TI "A-4�A"QN: $5829.00
DrISOWTTON OF WORK 2.9 kW PV (10) MODULE SOLAR ROOFTOP INSTALLATION, NEW, 125A SUB -PANEL TO BE
INSTALLED, EXISTING SOLAR SYSTEM INSTALLED
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