B-2018-0676 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0676
19978 RODRIGUES AVE CUPERTINO,CA 95014-3197(369 04 047) TESLA ENERGY
OPERATIONS,INC,
FREMONT,CA 94555
OWNER'S NAME: DATE ISSUED:05/01/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C10.C46 Lic.#888104
Contractor TESLA ENERGY OPERATIONS.INC.Date 12/31/2018 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)10-PANEL ROOF MOUNTED RV SYSTEM(3.25 KW)
I hereby affirm under penalty of pmjury one of the following two declarations: REV#1 LAYOUT OF PANELS HAS CHANGED-SEE SHEET 2&4-
r. I have and will maintain acertificate of consent to self-insure for Worker's ' ISSUED 06/21/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
have nod will maintain Worker's Compensation Insurance,as provided£or by
Section 3700 ofthe Labor Code,for the performance of the work for which this
Permit is issued. Sq.Ft Floor Area: Vxlmitio a$4810.00
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: Occupanoy'rype:
and slate laws relating to building construction,and hereby authorize 369 04 047
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,casts,and expenses which PERMIT EXPIRES IF WORI{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 regul t n per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Slgnalure Date 06/21/2018 Issued by:Jasmine Archbold
Date:05/01/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lmv Ior one of the RE-ROOFS
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree w remove all new nmterials 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 of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:06/21/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 die work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
I I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous matea ids 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 f 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 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 Henith&Say
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized.'em,
APPLICANT Ch312TIFICA3'ION Data:06/21/2018
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.)
toenter 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 ARC H I•I'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06/21/2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0676
19978 RODRIGUES AVE CUPERTINO,CA 95 014-3 1 97(369 04 047) TESLA ENERGY
OPERATIONS,INC.
SAN MATEO,CA 94402
OWNER'SNAME: DATE ISSUED:05/01/2018
OWNER'S PRONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C10.C46 Lic.#888104
Contractor TESLA ENERGY OPERATIONS.INC.Date 1 213112 01 8 X BLDG_ELECT_PLUMB
I herebyaffirm that 1 am licensed ander the f Chapter 9 ommenein —MECH X RESIDENTIAL—COMMERCIAL
provisions o p (c g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)10-PANEL ROOF MOUNTED RV SYSTEM(3,25 KW)
I hereby affirm tinder penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 a£the Labor Code,for the
performance of the work for which this permit is issued.
r�
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: Occupaucy'rype:
and state laws relating to building construction,and hereby authorize 369 04 047
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 Ilabillties,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
I hereby affirm that I am exempt from the Contractor's License Law fat-one of the RE-ROOFS:
following bvo reasons: All root's shall be inspected prior to any roofing material being installed.Ito roof is
1. I,as owner of the 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(Scc.7044,Business&Professions Cade)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/01/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVEli1NG5 TO BE CLASS"A"012 BETTER
I 1 have and will maintain a Certificate of Consent to self-insure fat Worker's
Compensation,as provided for by Section 3700 of the Labor Code,For the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation lnsurence,as provided Por by 1 have read the hazardous materlols requh'counts 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
s. I certify that in the pm oomme.of the work for which this permit is issued,I Health&Surety Code,Section 25532(a)should 1 store or handle hazardous
material.Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the r contaminants as defined by the Bay Area Air Quality Management District 1
Woker's Compensation laws of California.If,uRer making this certificate of will maintain cnmplf"'with d Cn is if..Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&
APPLICANT CERTIFICATION Date:05/01/2018
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 ARCHI'rEC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/01!2018 Licensed
Professional