B-2018-0494 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0494
10189 S FOOTHILL BLVD CUPERTINO,CA 95014-2601(342 14 121) CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:03/22/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SOLA @ Lie.#aIQB-49
Contractor CLEAN SOLAR INC Date 02/29/2020 X BLDG x 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)13-PANEL ROOF MOUNTED PV SYSTEM(4.65 KW);(N)PV
I hereby affirm under penalty of perjury one of the following two declarations: LOAD CENTER(60 AMPS);(N)AC LOAD CENTER(125 AMPS)
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REMOVE LOAD CENTER FROM SCOPE OF WORK-
ompmsation,as provided for by Section 3700 of the Labor Code,for the ISSUED 4/5/2018
Jperformance of the work for which this permit is issued.
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:$19104.00
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 342 14 121
representatives of this city to enter upon the above mentioned property for
Inspection purposes. (We)agree to sate-fntla?I4mify. d keep harmless the
City of Cupertino Inst liabilities,judgments,costs,a d expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai at aid city in consequence of the gra ting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the
ectlon 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 41512418 Issued by;Abby Ayes ndc
Date:03/22/2018
O6ML R 'CLARATIOI hereby at I am exempt from a Court lor's License Law for one of the RE-ROOFS•
following a: A11 roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or ogees with wages as their sole installed without fast 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. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:4/5/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation mammas,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 sad the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Settle.25532(a) d I store or handle hazardous
shall not employ any person in any manner so as to became subject to the material.Additionally,should I use aqui en[ r devices which emit-h ardous
air co¢taminants as defined by the Bay res A Quality Managamgpt Die let I
Worker's Compensation laws of California.If,atter making this certificate of wig maintain camphance with the Cup r. u¢leip"I e,Chapter 9. and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co _
APPLICANT CERTIFICATION Date:4/5/2018
I certify that I have read this application and state that the above information Is I G G6for
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is IV air ct on lending agperformance
relating to building construction,and hereby authorize representatives of this city of work's for which this perm Iglsy ed(Sec.3097,
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 TON AaD
Code,Section 9.18. 1 understand my plans shall be used public
records.
Signature Date A1512018 Licensed
Professional