B-2018-0771 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0771
10867 E ESTATES DR CUPERTINO,CA 95014-4533(369 22 022) SEMPER SOLARIS
CONSTRUCTION INC
EL CAJON,CA 92020
OWNER'S NAME: DATE ISSUED:05/07/2018
OWNER'S PHONE: PHONE NO:(619)715.4054
LICENSED CONTRACTOR'S BUILDING PERMIT INFO:
License Class B Lic.#978152
Contractor SEMPER SOLARIS CONSTRUCTION INC Date 10/31/2018 X BLDG X ELECT_PLUMB
1 hereby affirm that 1 nm licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Prof-hares Code and that my
license is in tall force and effect JOB DESCRIPTION:
(N)16-PANEL ROOF MOUNTED PV SYSTEM(596 KW);INSTALL
I hereby affirm tinder penalty of perjury one of the following tiro declarations: (N)SUB-PANEL(125 AMP)
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.
vjio, 1 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:$25920.00
APPLICANT CERTIFTCATION
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 stale laws relating to building construction,and hereby authorize 36922 022
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 / Date 05-07-2018 Issued by:Kim Dunbar
Date:05/07/2018
OWNER-BUILDER DECLARATION
I hereby oflirnr that I am exempt from the Contractor's License Law for one of theRP ROOFS•
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner ofthe properly,or my employees with wages as their sola installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the sat achue is not intended er offered too inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner ofthe property,am exclusively contracting with lecowd Signature ofApplieanu
contractors to construct the project(See.7044,Business&Professions Code). Date:05-07-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTOR
t. I have and will maintain a Certificate of Consent self-insure
to for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of bre 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 nmterfots requi cements 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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance ofthe work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should I stare 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
' r cont anrinonts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making ibis certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CER"PIFICATION Date:05-07-2018
I certify that I have read this application and slate 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
co nsequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCIO'I'EC'1"S UPCLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05-07-2018 professional