B-2018-0559 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-055`9
22356 RANCHO VENTURA ST APTA CUPERTINO,CA 95014-2736(357 03 055) CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:04/0512018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#910849
Contractor GLEAN SOLAR INC Date 02/29/2020 X BLDG ELECT—PLUMB
I hereby affirm that I nm licensed tinder the provisions of Chnptm'9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Cure and that my
license is in full force and effect. JOB DESCRIPTION:
INSTALL(N)POWERWALL TESLA WITH INTEGRATED INVERTERS
I hereby affirm under penalty of perjury one of the following five declarations: AND AN AUTOMATIC DISCONNECT SWITCH
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#I REVISE CONDUIT SIZE FROM 0/4"TO 3/4"EMT ON PAGE
Compensation,as provided for by Section 3700 of the Labor Code,for the E-I-ISSUED 05/07/2018
erformamce of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided Corby
Section 3700 of the Labor Code,for the.performalrce of the work for which this
permit is issued. Sq.Pt Floor Area. Vnlwttion:$7501.00
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 357 03 055
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agren"d
e inde7SIruCtLo
d- ep harmless the
City of Cupertino ago ngNagilitients, nd a arises which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against s1/pfd Olty�inence rantin of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the app cant undend wilwl all non-point
source regulations er th upicipaoften 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signa re_� Date 05/07/2018 Issued by:Abby Avendc
Data 04/OS/2018
O ER- IL ER DECLARATION
I rcby affirm that I am exemp(Im C lLicense Law Car one of the RE-ROOFS:
All roofs shall be inspected prior to ayroofing material being installed.Ifs roofis
1. 1as owner of the propemplory wages as their solo nstalled without first obtaining an inspection,I agree to remove all new materials lar
nd thee isnot intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicamt
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:05/07/2018
1 hereby affirm under penalty,of perjury one of the following three declarations: ALL ROOF COVERINGS TO 13E CLASS"A"OR BETTER1. 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,far the
performance ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements ander Chapter 6.95 of the
Section 3700 of the Labor Cade,for the performance of the work for which this California Health&Safety Code,Secfions 25505,25 rid 25534.[will
permit is issued. maintain compliance with the Cupertino Muntet al Code,Chap .12 and the
s. I certify that in the performance of the work for which this permit is issued,I Ilealth&Safery Code,Seaton 25532(p)-slr old 1 stare or boodle ha rdous
shall not employ any person in any manner sons to become subject to the matminl.Additionally,' "1 use pm 1 or devices whleh emit 1 azurduus
contaminants as defined by the B y Area I,Quality Nlanageme District 1
Worker's Compensation laws of Californis.If,atter making this certificate of .itwillcmainL in cool liance with the C penin Municipal Code,Ch. er 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Saf�y-God os 25 O5,25533,an x534.
Labor Code,1 nnlst forthwith comply with such provisions c r this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/07/2018
I certify that I have read this application and state that the above information is C
performance
relating to bonding construction,and hereby authorize representatives of this city of work's for which this rmit is' ued(Sec.
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 complywith 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 Data 05/07/2018 Licensed
Professional