B-2018-0665 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0665
10395 WUNDERLICH DR CUPERTINO,CA 95014-3645(375 16 029) SLINGSHOT POWER
INC
LOS ALTOS,CA 94022
OWNER'S NAME:GOPALAN BADRI PAND SUDARSANAM HARINI DATE ISSUED:04/23/2018
OWNER'S PHONE: PHONE No:(650)308-9055
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=46 Llc.#984488
Contractor SLINGSHOT POWER INC Date 0613012019 X BLDG ELECT_PLUMB
1 hereby affirm that I am licensed under 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 full force and effect, JOB DESCRIPTION:
(N)12-PANEL ROOF MOUNTED PV SYSTEM-(3.96 KW);
I hereby affirm under penalty of perjury one of the following two declarations: (N)EV CHARGING STATION-(50 AMPS)-GARAGE
r. I have and will maintain a certificate of consent to self-insure for Worker's
Co pensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work forwhich this permit is issued,
I have and will maintain Worker's Compensation Insurance,us provided for by
Section 3700 of the Labor Code,for the perfmarance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANTCERTIFICATION
I certify that I have read this appllcatlon 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 375 16 029
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,casts,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
ss urrWreulotlalaer the�Cuu�pertinoMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign
Date 04123/2018 Issued by;Jasmine Archbold
Date:04/23/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE- DES,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.He roof is
r. 1,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
ompensod"'will do the work,and the structure knot intended or offered for inspection.
sale(&&.7044,Business&Professions Code)
z. 1,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicanu
contractors to construct the project(Sec.7044,Business&Professions Code), Date:04/23/2018 _
1 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
Parfet mance of the 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 have read the hazardous materiots 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. nn aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. f 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
airontaminnuts as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California if,after making this certificate of willmaintaincontpllaneewith the CnpertJ������QQQQQQ Municipal Code,CI er 9,12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Sn ty CoA Sectio`rs3y$$
APPLICANT CERTIFICATION Date:04123/2018
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 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 ARC II ETC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureDate 04123/2018 Licensed
Professional