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B-2017-0488CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0488 20500 TOWN CENTER LN CUPERTINO, CA 95014 (369 55 999) CLEAN SOLAR INC SAN JOSE, CA 95112 OWNER'S NAME: David Yu DATE ISSUED: 04/26/2017 OWNER'S PHONE: 408-621-4097 PHONE NO: (408) 217-8876 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class SOLAR Lic. #910849 Contractor CLEAN SOLAR INC Date 02/28/2018 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X 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) 175-PANEL ROOF MOUNTED PV SYSTEM (57.225 KW) I here affirm under penalty of perjury one of the following two declarations: 06-09-2017 -REV#1 -BALLAST WEIGHT DECREASE TO 8.6 PSF.- I have and will maintain a certificate of consent to self-insure for Worker's ISSUED 6/19/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by have Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $203975.00 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 369 55 999 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 applic pt understands a mply with all non-point source regulations e Cupertino m ipal C de, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. p Signature Date 6/19/2017 Issued by: ABBY AYENDE Date: 04/26/2017 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 t. 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) z. 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: 6/19/201 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. 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 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 t Quality Managem District I air contaminants as defined by the BFe- Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cunicipal Code pter 12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code,505, 25533 n 534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANTCERTIFICATION Date: 6/19/2017 I certify that I have read this application and state that the above information is LENDING AGEN!Q correct. I agree to comply with all city and county ordinances and state laws 1 hereby affirm that ther is a cotruction lending agenc or the performance relating to building construction, and hereby authorize representatives of this city of work's for which this per 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 6/19/2017 Professional ALTERNATIVE ENERGY PERMIT APPLICATION itsCOMMUNITY DEVELOPMENT DEPARTMENT- BUILD C DI��SION 10300 TORRE AVENUE • CVPERTINO, CA 950'14.3255 LAE GUPI~RTlN4 (408) 777-3228 •FAX (408) 77i-3333 • buildin cu t'rtino,c�--u r l —0q ^ 15 rRnttI('TADI�R�eS�ArN#%.. OWNER X.01 F & STREETAMMS ry' /,f �j {�/}�� CJ - i �f . I % _. - > r✓ / �. • � - CtiY, STAT 7..If' /^ J� j fy -•� PAX ... �.. --(,._ -'".L ,�'j/ '.fes � t Or I'AL`i' )`ARIL'{ PROW`tll /" / ,,,�� ����.. r AiAllarl SfA@ET T FAX © 01YNLR Q owm7A.nuitmit ❑ ONVARAQENT �.(1)1rRAt mit ❑f.ormiL:iORAG1-,N*I' 13 ARCIR't KI' ❑ I:`1tilNl:tRt 13 pivre.[}pkH Q TAimm CONTRACTOR NA i.-- E lCT BUS. tGyJ j COM FANY 1AMI.' H. FAX IwRrFT Anl*F.SS �j 4 { �( f ARC UIVICT-T 11tiEPANAM6. 1 UCENSUNUMBI-A BUS.LICN CU�tt :'YNAME rAIAll. FAX a 1'Rrx.TADDURC C11Y.iTAi'B. ql' Atom ' VISI: 01; O SFJ) of Duplex Multi-Fatltily S"fnt3CtUILE: _vltl[lSel'Gtdl rkn)f: TIN WILDLAND VRBAN INITAFACII AWik ❑ Y No PROMMN F'LOODYONL ❑ YCS N() "OLARPANfI;S.1 ❑ C:I,1;'CCtiti'IiE.IIIc-LECI1M1ItCUNCiS'1'A'1'lOt. TO 50LARWAi ULIA'11140 70 immu FfJRSfiL 1R.1'A.47 f8 Nt1.4161:R OP pAt:1:1,StUNITS: KII.oA4tT R (COS,IYt@-ACIAI,ON1,Y); TOT'AT. VAI,[IATIt7N: 11FSt'k1P'f(ON OP WORK �Ri. 'D [ by my signatury below, 1 ceflify m ead n£Hf1p ollow Ig: t alp Ilse pn)p ©j( y rx olltht�tir�d vJtt th 1et nt► tltr ptt ity tt;.b« �'u N�6�1f. t IWte 1 2d Iltis application and tlit: luf4tatmi7n T have- tliti•,5e'Qed is, - 5 i'C6"t, I. ltrix` cC d �.+@��45uiptiun o 'Work verify it is 7[CCUIatc. I abi' 1'U IO comply with all applicable local 1N111a-alwe8-U11t1 sude laws rotating 10 W � siluctlon. I'ant11M4, ptcscntati YCs til' dino to cot¢Cdlc abU 1(1C 1£1Cd p[Ol]l-ay tLli lnSpgction purposvi. :ignalumofApplicant!Abnnt:_ ' 1 t St1l' L'113M.dNTAL INFW'iX1 5N1EQUiREll OFFICR:[.t41:t'ONIS 0 -048R-M1r'C0i%%MR a >itm.'.R 13: 6i:4N1? 1RD L b ❑ , P1AJOlt Pi:4pp ;!)! l.doc rrvivmF03116111 km CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20500 TOWN CENTER IN CUPERTINO, CA 95014 (369 55 999) CONTRACTOR: CLEAN SOLAR INC PERMIT NO: B-2017-0488 SAN JOSE, CA 95112 OWNER'S NAME: David Yu DATE ISSUED: 04/26/2017 OWNER'S PHONE: 408-621-4097 PHONE NO: (408) 217-8876 LICENSED CONIRACTOR'S CONTRACTOR'SDECLARATION BUILDING PERMIT INFO: License Class SOLAR Lic. #910849 Contractor CLEAN SOLAR INC Date 02/28/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X 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) 175 -PANEL ROOF MOUNTED PV SYSTEM (57.225 KW) 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. - z r 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: $203975.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 369 55 999 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 may accrue against'satd City in consecLuence of the of this PERMIT EXPIRES IF WORK IS NOT STARTED granting permit. Additionally, the appli ant unders ds an will comply with all non -point ' WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulatiolbs p r the Cup i 6 Mu ipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. f�(, Signat e` .test Date ` Issued by: Phuong Devries Date: 04/26/2017 R- D E I her y rm 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 i. 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) z. 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: I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 equip} ept or devices whieh em�rt hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area/Aur Quality nagemept District I will maintain compliance with the Cup rtrggo Municipa Code, Clia ter 9.12 and ','dns exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code 25505, 2 3, and 2 34. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:' % L_ APPLICANT CERTIFICATION Date: �/ r I certify that I have read this application and state that the above information is to correct. I agree to comply with all city and county ordinances and state laws I hereby affirm t at there is a coy sduction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit 's 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 DECL RATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE CUPERTINO (408) 777-3228 • FAX (408) 777-3333 - buildinaCcr7.cupetino.orq P r- FROJCCf ADDRESS � �d � � APN # ...T . _ t OWNERNAMP. � � pa�E f (�ZI � � wv� p• E-�MAIL '•'[.• STREET ADDRESSJx J� C ,STA . (25:417116 FAX CONTACT NAME Gas,, ince r > „� j fi� STP GL+TAD j/( ] (❑OWNFRAOSNT f CA_tI� f❑ PAX ll OWNER ❑ OWNER -BUILDER � C NTRACTOR El CONTRACTOR AGENT ❑ ARCIIITECT ENGINEER ❑ DEVELOpliR ❑ TENANT CONTR f fj�1� A ( C) t0 U ( I IJ P (.01 BUS. LIC# E -M }L FAX S REE± S • J .� ! -./ C11'Y, 11' C %j W / f llJe3'iAC� •� J ARCHITECTIENOIN, NAME LICENSE NUMBER BUS. LIC # com AME E-MAIL FAX ,81'REET CI ,STATE -ZIP -IONS USE Or ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: rxunercial PROJECT IN WILDLAaND 11R13AN INTERFACE AREA ❑ Yes O PROJECT IN FLOOD ZONF. ❑ Yes VIVO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STA.110N ❑ SOLAR WATER HEATING ❑ OTHER: JTORSOf.ARPANELS. NUMBER OFPANELSIIJNITS: ICILOWATTS(COMM LO Y- TOT TIO m4 cc DESCRIPTION OF WORK V r. By my signature below, I certify to each of the foil i I am the nparty ner authorized age to act on the property owners behalf. I have read this application and the information I have provided i c root. I have ad the o ption of Work a verify ii is accurate. T agree to comply with all applicable local ordinances and stale laws relating to I 1 structio` }}. I authorizer )resentatives of C rtino to enter the above -identified property fpr inspection purposes. Signature of Applicant/Agent Date: � /�/ ((��j'j PPI NTAL INFORMATIONU RED PVAJ)p 2011.doc revised 03116111 60 'JAr, e'e)n%