B-2018-0875 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0875
19010 BARNHARTAVE CUPERTINO,CA 95014-3502(375 37 041) TESLA ENERGY
OPERATIONS,INC.
FREMONT,CA 94555
OWNER'S NAME: DATE ISSUED:05/22/2018
OWNER'S PHONE: PHONE NO:(650)681-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#$88104
Contractor TESLA ENERGY OPERATIONS,INC Date 12/31/2018 X BLDG—ELECT—PLUMB
1 hereb affirm that I am licensed under the s of Cha ter 9 —MECH X RESIDENTIAL_COMMERCIAL
y n provision p (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)S-PANEL ROOF MOUNTED PV SYSTEM(2.6 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-RELOCATE LOAD CENTER AND INVERTER TO INSIDE
n. I have and will maintain a certificate of consent to self-insure for Worker's THE GARAGE-ISSUED 07/25/2018
Compensation,as provided herby Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
��z. 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 for which this
Permit is issued. Sq.Ft Floor Area: Valuation:$3848.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 375 37 041
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:
Signature Data Issued by:Jasmine Archbold
Date:05/22/2018
OWNER-
I hereby affirm that I am exempt front the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All roofs shall be inspectedprior to any roofing material being installed.If a root'is
1, 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(Scc.7044,Business&Professious Code)
z I,as owner of the property,am exclusively contracting with licensed Signature ofApplieanC
contractors to constant the project(Sec,7044,Business&Professions Code), Date:
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 o£the Labor Code,for the
performance ofthe 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 hove read the hazardous materials requirements under Chapter 6.95 or 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 Cade,Chapter 9.12 and the
a. 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 Imzardous
shall not employ any person in any manner so as to become subject to the materiul.Additionally,should 1 use equipment or devices which emit hazardous
ontaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califbnuia.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 tine Healtlu&Safety Cud:, �tions 25505,25533 and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent: -
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above Information is CONST N LE D 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 clty 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.
SignatureData Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0875
19010 BARNHART AVE CUPERTINO,CA 95014-3502(375 37 041) TESLA ENERGY
OPERATIONS,INC.
SAN MATEO,CA 94402
OWNER'S NAME: DATE ISSUED:05/22/2018
OWNER'S PHONE: PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: '
License Class PLUMBING Lic.#888104
Contractor TESLA ENERGY OPERATIONS INC Date 12/3112018 X BLDG_ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
1 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 aad effect. JOB DESCRIPTION:
(N)8-PANEL ROOF MOUNTED PV SYSTEM(2.6 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 for which this
permit is issued. Sq.Ft Floor Area: Valuation:$3848.00
APPLICANT CF.RTiFICATION
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 375 37 041
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 regul ' Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5122/2018 Issued by:Jasmine Archbold
Date:05/22/2018
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
r. 1,as owner of the property,a 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(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construcl the project(Sec.7044,Business&Professions Code). Date: 225/ /2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self4usam for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
patirmrance 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 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
3. 1 certify drat 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 employ my person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensationype laws of y manner If,after become
this certificate o£ air contaminants as defined by the Bay Area Air Quality Management District I
g will maintaincomplianh t e ce witCupertino Municipal Code,Chapter 9.12 and
exemption,I become subj act to the Worker's Compensation provisions of the the Health&Snfety and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shalt ------'�+
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:512212-1_
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 5122/2018
Professional