B-2018-1017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-20181017
20725 SUNRISE DR CUPERTINO,CA 95014-2928(359 10 028) AMERICAN HOME
ENERGY MC
ROSEVILLE,CA 95678
OWNER'S NAME: DATE ISSUED:06/15/2018
OWNER'S PHONE: PHONE NO:(916)275-3559
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lic.#1039756
Contractor AMERICAN HOME ENERGY INC Date 05/3112020 7S BLDG—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 fall force and effect. JOB DESCRIPTION:
(N)27-PANEL ROOF MOUNTED PV SYSTEM(9.045 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
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 far which this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above
Information Is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 359 10 028
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 S'T'ARTED
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 Cu ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-15-2018 Issued by:Kim Dunbar
Date:06/15/2018
OWNER-BUILDER DECLARAP N
1 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 prim to any roofing material being installed.If a 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 streeture is not intended or offered for inspection.
sale(See.7044,Business&Professions Code)
x. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant
contractors to construct the project(Sec.7044,Business&Professions Code), Date:06-15-2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"012 BETTERr. 1 have and will maintain a Certificate of Consent to Wf-firsure 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
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materlots requirements under Chapter 6.95 of the
Section 3700 of the L.bm Code,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. m.fate[.compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)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 coohuninamts as defined by the Bay Are.Air Quality M...gament District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Muni[pal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the fine health&Safety Code,Sections 255 25533,aad 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06-15-2018
I certify that I have read this application and state that the above Information Is - 'N I G A E CY -
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending ag cy 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. 1 understand my plans shall be used as public records.
Signature Date 06-15-2018 Licensed
Professional