B-2018-0752 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0752
10305 ELPRADO WAY APT A CUPERTINO,CA(34230015) LASOLARGROUPINC.
VAN NUYS,CA 91406
OWNER'S NAME: DATE ISSUED;05/03/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Up.#974115
Contractor LA SOLAR GROUP INC Date 06/30/2018 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed tinder the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fail tons and effect JOB DESCRIPTION:
(N)17-PANEL ROOF MOUNTED PV SYSTEM(5.61 KW);(N)SUB
I hereby affirm under penalty of perjury one of the following two declarations: PANEL(125 AMP);INSTALL EV OUTLET IN GARAGE.
i. 1 have and will maintain a certificate of consent to self-insure for Worker's REV#1 PANEL UPGRADE(200 AMP)
performance of the work for which Ibis permit is issued.
z. 1 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: Vrdmitiun:$8000.00
APPLICANT C-E—RTIFICATION
I certify that I have read this appllcatlon and slate 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 342 30 015
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 aMCItyin
judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accr7agal nsequence of the granting of this permit. VyITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionapnds and will comply with all non-paintsourcereso Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/07/2018 Issued by:AbbyAAyende
Date:05/03/2018
OWNER-BUILDDECLARATIO
I hereby affirm that t am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any rooting material being installed.If's root'is
t. 1,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 napeamr.
sale(So,'7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:06/07/2018
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 self4inaire For Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of ire work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I hnve 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 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the perforu once of the work for which this permit is issued,I Hoalth&Safety Code,Section 25532nd should I store at-handle hazardous
shall not employ n in an manner so as to become subject to the material.Additionally,should I use equipment or devices which craft hazardous
p y any person y J air co itiond ants as del'med by the B Area At,-Quality Mamigement District 1
Worker's Compensation laws of California,If,after making this certificate of will maintain compliance whin the pertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cory,Sections 25505,25533,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:06/07!2018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 Nama
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.
SignatureLicensed
Date 06!07!2018
Professional