B-2018-0309 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0309
21450 COLUMBUS AVE CUPERTINO,CA 95014-4971(362 05 003) GREEN POWER
INSTALLERS MC
SANTA CRUZ,CA
95060
OWNER'S NAME: DATE ISSUED:02/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 100 Le.#952145
Contractor GREEN POWER INSTALLERS INC Date 09/3012018 a BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH$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(1)TESLA POWER WALL BATTERY;(1)SUBPANEL(125
I hereby affirm under penalty of perjury one of the following two declarations: AMP3)
L 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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
I certify that I have read this applicatlon and slate 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 362 05 003
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 erstands and will comply with all non-point
source regulation per th upertino Municipal Code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Skinatuna Date 2/20/2018 Issued by:Abby Aygnde
Date:02/20/2018
ODEGLTION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs sboll be inspected prim to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages ns their sale 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(See.7044,Business&Professions Code)
z. I,as owner ofthe property,are exclusively contracting with licensed Signature mApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:2/20/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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
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 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 Code,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 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 defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califomia.If,after making this certificate of wi l 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 Code,Sections 25 A 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall 5
be deemed revoked. Owner or authorized
APPLICANT CERTIFICATION Date:2/20/2018
I certify that I have read this application and state that the above Information Is CONSTRU G AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a 66nstructlon 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 212012018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0309
21450 COLUMBUS AVE CUPERTINO,CA 95014-4971(362 05 003) GREEN POWER
INSTALLERS INC
SANTA CRUZ,CA
95060
OWNER'S NAME: DATE ISSUED:02/20/2018
OWNER'S PHONE: PHONE NO:(
BUILDING PERMIT INFO:
License Class a Lic.#5 5
Contractor GREEN POWER INSTALLERS INC Date 09/30/2018 X BLDG X ELECT_PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
p 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:
INSTALL(1)TESLA POWER WALL BATTERY;(1)SUBPANEL(125
I hereby affirm under penalty of perjury one of the following two declarations: AMPS)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#I-REMOVE SUBPANEL(125 AMPS)-ISSUED 06-I8-2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:312000.00
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 36205 003
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 applic t understands and will comply with all non-point
source regulations p e-Cupertino Municipal Code,Section 9,18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign - Data 06-18-2018 Issued by:Abby Ayende
Data:02/20/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing material being installed Ifs roof is
1. 1,as o nerafthe 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(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature o£ApplicanC
contractus to construct the project(Sec,7044,Business&Professions Code). Date:06-18-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO 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. 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 Cade,Sections 25505,25533,and 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance ofthe work for which this permit is issued,I Ilealth&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not em to person in an inner so as to become subject to the material,Additionally,should I use equipment or devices which emit hazardous
p y any pe y m` 1 an,contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California If,slier making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,1 become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 255 ,25533,end 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen
APPLICANTCEI2'fIFICA'1'10N Date:06-18-2018
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.
Signature Date 06-18-2018 Licensed
Professional