B-2017-1879 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1879
10535 MIRA VISTA AVE CUPERTINO,CA 95014-2707(357 05 040) SUNPOWER
CORPORATION
SYSTEMS
• SAN JOSE,CA 95134
OWNER'S NAME: RAUT VIRAJ AND VRUSHALI DATE ISSUED: 11/01/2017
OWNER'S PHONE:408-464-1502 PHONE NO:(941)720-3850
LICENSED CONX CTOR'S DECLARATLON BUILDING PERMIT INFO:
License Class PSR Lic.#890895 X BLDG x ELECT _PLUMB
Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2019
MECH JX 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(6.48 KW);(N)
Thereby affirm under penalty of perjury one of the following two declarations: SUBPANEL(100 AMPS)
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
t-rformance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
1/.'-^1' Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5000.00
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 357 05 040
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. 180 DAYS FROM LAST CALLED INSPECTION.
Sig re Date 11/1/2017 Issued by:AbbyAyende
Date: 11/01/2017
OWNER-BUILDER DECLA ON
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
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 they 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 pioject(Sec.7044,Business&Professions Code). Date:11/1/2017
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
perforntance,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 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
be deemed revoked. r authorized agent:
APPLICANT CERTIFICATION ,p•'e:11/1/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LEND GENCY
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 11/1/2017 Professional
\� ALTERNATIVE ENERGY PERMIT APPLICATION
: COMMUNITY DEVELOPMENT DEPARTMENT•.BUILDING DIVISION kiV
�ST.,DS AE
10300 TORRE AVENUE•,CUPERTINO, CA 95014-3255:
CUPERTINO (408)777-3228•FAX(408)77.7-3333*buildinq@cupertino.orq
•
PROJECT ADDRESS - APN#
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❑OWNER - ❑ OWNER-BUILDER ❑"OWNER AGENT E CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER - ❑-DEVELOPER _ 0 TENANT
CONTRACTOR NAME •- LICENSE NUMBER LICENSE TYPE • • -BUS.LIC#
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USE OF lJ IFD or Duplex ❑ Multi-Family - :PROJECT IN WILDLAND PROJECT"IN
URBAN INTERFACE AREA ❑ Yes ' NO FLOOD ZONE . :❑ Yes IsNO
STRUCTURE: ' ❑ Commercial Q
12ISOLAR PANELS. .0, ELECTRIC VEHICLE CHARGING STATION . " 0 SOLAR WATER HEATING. 0.OTHER:.,
FOR SOLAR PANELS; NUMBER OF PANELS/UNITS: KILOWATTS(cogmEKIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK
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- ,. - - . . RECEP✓ED BY:' I `' -',
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act onthe property owner.s'b have re d this •
application and the information I have provided is correct I h. "read the Description of Work and verify itis accurate. I agree to comply with"all applicable local
ordinances and state laws relating to build' g-construction. autho e representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: (4
SUPPLEMENTAL INFO•'°iiTION REQUIRED OFFICE•USE'ONLY
WW ❑•OVER-THE COUNTER
F ❑ EXPRESS
su,Ri. ❑ STANDARD.. - •.
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❑ LARGE
MAJOR t
PVApp 2011.doc revised 03/16/11