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B-2017-2035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2035 20957 FAIRWOODS CT CUPERTINO,CA 95014-4200(359 13 113) BAY AREA SOLAR SOLUTIONS INC PLEASANTON,CA 94588 OWNER'S NAME: JI RUCHUN AND YANG YINGHAO DATE ISSUED: 11/28/2017 OWNER'S PHONE:408-334-9173 PHONE NO:(925)380-9500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#928652 Contractor BAY AREA SOLAR SOLUTIONS INC Date 02/28/2019 X BLDG X 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)EV CHARGING STATION(40 AMPS);UPGRADE SUBPANEL(200 I hereby affirm under penalty of perjury one of the following two declarations: AMPS) 1. I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as providedfor by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 44,4r;' have and will maintain Worker's Compensation Insurance,as provided for by Atfp Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500.00 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 13 113 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. gT rire� M Date 11/28/2017 Issued by:Abby Ayende Date: 11/28/2017 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 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) 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:11/28/2017 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 maintaina 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 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. � „ a'f a`or authorized agent: • APPLICANT CERTIFICATION ©•te:11/28/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENC 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,end 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 11/28/2017 Professional ?J-WR-205 \ // ALTERNATIVE ENERGY PERMIT APPLICATION AE ' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0.J,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinc cupertino.orq PROJECT ADDRESS APN# 359131 13 20957 FAIRWOODS CT. OWNER NAME RUCHUN JI PHONE 408-334-9173 E-MAIL"Jiruchun12 @gmail.com STREET ADDRESS 20957 FAIRWOODS CT. CITY,STATE,ZIP FAX Cupertino.Ca.95014 CONTACT NAME John WoolwayPHONE 9253809500 ohn.woolwa � y@you[energysolutions.com STREET ADDRESS CITY,STATE,ZIP FAX 6700 Santa Rita Rd p1Pacantnrt,C:A, cI45RR ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT ❑CONTRACTOR 13/CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Lou Zaughbaba 928652 C10 COMPANY NAME E-MAIL FAX Your Energy Solutions I nu 7aughhaha r@ynurenergysn6rtions corn STREET ADDRESS CITY,STATE,ZIP Pleasanton,CA,94588 PHONE 6700 Santa Rita Rd 9253809500 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS � CITY,STATE,ZIP PHONE / USE OF E SFD or Duplex El Multi-Family PROJECT IN WI.DLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA 0 Yes NNo FLOOD ioNE 0 Yes Ls(No Il SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 1 KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: $500 DESCRIPTION OF WORK ate, / r' Installing an EV charger Located in the Garrage - /7 G..„,- 666/ U ci _ . RECEIVED 13Y: ' .\,444 Iv/� 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 beh f. I ha a 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 to comply with all applicable local ordinances and state laws relating to building construction.I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: • /a ./ -',d. , Date: 11/21/17 SUPP; I AL INFORMA ✓ REQUIRED ' OFFICE USE".ONLY _. ❑ OVER THE COUNTER I 'r a❑:EXPRESS d x t .1 ❑.STANDARD N ❑ LARGE .4.'i O MAJOR u+v. , �. f PVApp_2011.doc revised 03/16/11