B-2018-0857 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0857
10635 JOHNSON AVE CUPERTINO,CA 95014-3815(37527015) SUNWORKS UNITED
INC
ROSEVILLE,CA 95678
OWNER'S NAME: DATE ISSUED:05/18/2018
OWNER'S PHONE: PHONE NO:(916)409-6900
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class E Lie.4441620
Contractor SUNWORKS UNITED INC Date 12/31/2018 X BLDG X 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:
INSTALL POWERWALL(2)AC BATTERY SYSTEMS;INSTALL SUB-
I hereby affirm under penalty of perjury one of the following two decimations: PANELS(2)(200 AM)&(125 AMP)
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 Cade,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
�SSection 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$15500.00
APPLICANT CERTIFICATION
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 27 015
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 against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORT{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 th Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-18-2018 Issued by:Kim Dunbar
Date:05/18/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Brom the Contractor's License Law for one of the RF,12001'8•
fallowing two reasons: All roofs shall be inspected in to any roofing material being installed.If a roof is
t. L as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove oil new materials for
compensation,will do the work,and the structure is nut intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z 1,as owner of the property,am exclusively contracting With licensed Signature of Applicant:
contractors to consumer the project(Sec.7044,Business&Professions Code), Date;05-I8-2018
I hereby off'rm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
i. 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
z. l 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
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the materinl.Additionally,should lose equipment or devices which emit hazardous
Worker's Com ensatioe laws ofCalifornia,U,atimb become
ubjeut to,Cate o(' contaminants as defined by the Bay Area Air Quality Mmmagement District I
p S will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Code,Se tion;0715,11111,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed rovokcd. Owner or authorized agent•
APPLICANT CERTIFICATION Date:05-18-2018
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 05-18-2018 Professional