B-2018-1041 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1041
10405 MORETTI DR CUPERTINO,CA 95014-3683(375 14 015) MATTHEW WELCH
FELTON,CA 95018
OWNER'S NAME: DATE ISSUED:06/19/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL Lic.#500847
Contractor MATTHEW WELCH Date 02/28/2021 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)17-PANEL ROOF MOUNTED PV SYSTEM-(5.015 KW);(N)
1 hereby affirm under penalty of perjury one of the following two declarations: SUBPANEL(100 AMP);(N)EV CHARGING STATION(50 AMP)
A, 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 permitis issued,
2. I have and will maintain Worker's Compensation Insurance,as provided for by
permit is issued. Sq.Ft Floor Are.: Valuation:$17677.00
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 Nmnber: Occupancy Type;
and slate laws relating to building construction,and hereby authorize 375 14 015
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 co ply with all non-point
source regulations per the Cupertino Municipal C de,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/19!2018 issued by:Jasmine Archbold
Date:06/19/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All ..is shall be inspected in to any roofing material being installed.If. of is
r. I,as owner of the property,or my employees with wages as their sole instsIled without first obtaining an inspection,l agree to remove at I new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
set.(Sec.7044,Business&Professions Code)
a I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:06/19/2018
1 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 the 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 materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work For which this C.Itfm.Ns Health&Safety Cod,Sections 25505,25533,and 25534.I will
permit is issued. aintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I m Heulth&Safety Code,Section 25532(.)should I store m'handle h.zardous
shall not employ u n in an to become subject to tlrc material.Additionally,should I use equipment or devices which emit hazardous
p y a y person y manner so as J air contaminants as defined by the Bay Arc.Air Quality Management DisticI 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.1 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety
APPLICANT CERTIFICATION Date:06/19/2018
1 cerlify: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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Dale 06!1912018
Professional