B-2018-0805 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:R-2018-0805
21534 CONRADIA CT CUPERTINO,CA 95014-4801(356 23 053) QUICK SYSTEMS INC
LOS ANGELES,CA
90036
OWNER'S NAME: DATE ISSUED:05/10/2018
OWNER'S PHONE: PHONE NO:(
LENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_46 Lic,#997178
Contractor QUICK SYSTEMS INC Date 0913012018 X BLDG ELECT_PLUMB
I herebyaffirm that 1 am licensed tinder the p (commencing —MECH X RESIDENTIAL_COMMERCIAL
a to of Chapter 9
with Section 7000)of Division 3 of the Business&Professions Cede and that my
license is in full force and effect, JOB DESCRIPTION:
(N)21-PANEL ROOF MOUNTED PV SYSTEM-(6.090 KW)
1 hereby affirm under penalty of perjury one of the following two declarations:
t. 1 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
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the wok for which this
permit is issued. Sq.Ft Floor Area; Valuation:$18270,00
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 stale laws relating to building construction,and hereby authorize 35623 053
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 permlt. WITHIN 180 DAYS OF PERMIT ISSUANCE 012
Additionally,the applicant understands and will comply with all non-paint
source regulations per the Cupertino
�Municipal
_Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ll Date,05/10/2018 Issued by:Jasmine Archbold
Date:05/10/2018
OWNER-RIIILDER DECLARATION
I hereby affirm that I.,it exempt from the Cmdractor'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 root'is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,l 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 Signamn,ofApplirmit:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:05/10/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I have and will maintain a Certificate of Consent to self-insure fin oWorker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of die 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 materiels 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 Cade,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,1 Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ an n in an to become subject to the material.Additionally,should I ase equipment or devices whdch emit hazardous
p y� yon la y manner so as J r contaminants as defined by the Bay Arca Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the [lie Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
%
APPLICANT CERTIFICATION Data:05/10/2018
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/10/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0805
21534 CONRADIA CT CUPERTINO,CA 95014-4801(356 23 053) QUICK SYSTEMS INC
LOS ANGELES,CA
90036
OWNER'S NAME: DATE ISSUED:05/10/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=46 Lic.#997178
Contractor QUICK SYSTEMS INC Date 09/30/2018 X BLDG_ELECT_PLUMB
I 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)21-PANEL ROOF MOUNTED PV SYSTEM-(6,090 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-UPGRADE PANELS TO 24(6.960 KW)-ISSUED 5/17/2018
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
performance of the work for which this permit is issued.
-,d 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$18270.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Information is correct.1 agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 23 053
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 rMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature �� " 1Dale 5/17/201 B Issued by:- INwPJ��( ka,
Date:di.54=01Ii b n lb
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 ract is
L I,as owner of the properly,or my employees with wages as their sole installed without fust 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant
contractors to construct the project(Sce.7044,Business&Professions Code). Date: 115 7/1018
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
L 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 Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)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 defned 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
APPLICANT CERTIFICATION Data:511712018
1 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 Date 5!17/2018 Professional