B-2018-0675 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CON-RACTOR: PERMIT NO:B-2018-0675
10600 STOKESAVE CUPERTINO,CA 95014-1237(32649002) i'
- -AENERGY
t 3RATIONS,INC,
SAN MATEO,CA 94402
OWNER'S NAME: DATE ISSUED:05/01/2018
OWNER'S PHONE: PHONE NO:(650)9635100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C10 C45 Lie.#888104
Contractor TESLA ENERGY OPERATIONS INC Date 12/31/2018 X BLDG X ELECT_PLUMB
1 herebyaffirm that I am licensed under the provisions of CIm ter 9 _MECH X RESIDENTIAL_COMMERCIAL
n 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:
(N)22-PANEL ROOF MOUNTED PV SYSTEM(7.15 KW);SUB-
I hereby affirm under penalty of perjury one of the following two declarations: PANEL/LOAD CENTER(125 AMP).
E. I have and willmaintain 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.
Section 3700 of the Labor Code,for the performance of the work for which this.
permit is issued. Sq.Ft Fluor Area: Valuation:$10582.00
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 326 49 002
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 IIP 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 regal ns er the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/01/2018 Issued by:Jasmine Archbold
Date:05/01/2018
OWNER-BUILDER DECLARATION
I hereby arum that I am exempt front the Contractor's License Law for one of the RE-ROOKS•
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a or is
t. I,as owner of the property,or my employee with wages as(heir sole installed without first obtaining an inspection,I agree to remove all new materials for
ompensation,will do the work,and the structure is not intended or offered for inspection.
sale(S-7044,Business&Professions Code)
z. 1,ns owner of the property,am exclusively contracting with licensed Signature ofApplicane
contractors to constrict the project(Sec.7044,Business&Professions Code), Date:05/01/2018
1 hereby affirm under penalty at'perjury one of the following three decierstions: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 Code,for the
performance clan work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 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 Colil'ornta Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued maintain compliance with the Cupertino Municipal Code,Chaplin.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 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the mYcontaminants
Additionally,should 1 use equipment or devices which emit hazardous
as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California. If,after making this certificate of w111 maintain wmpllonea with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health 8,Safety C Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
AI'PLICAN'1'CERTIFICATION Date:05101/2018
I certify that I have read this application and state that the above information is IX)NS'fRUCT[ON 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-paint source regulations per the Cupertino Municipal ARCHI't'EcT S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/0112018 Licensed
Professional