B-2018-1108 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1108
11455 CHARSAN LN CUPERTINO,CA 95014-4981(36210050) SUNPOWER
CORPORATION
SYSTEMS
RICHMOND,CA 94804
OWNER'SNAME: DATE ISSUED:07/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.4890895
Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2019 X BLDG ELECT—PLUMB
I hereby affirm that I am licensed tinder 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)t4-PANEL ROOF MOUNTED PV SYSTEM(5.04 KW)
1 hereby affirm tinder penalty of perjury one of the following two declarations:
1. 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 lire
performance of the work for which this permit is issued.
is issued. Sq.Ft Floor Area: Valuation:$10000.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 362 10 050
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 id City in onsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the appl nl unde nds and will comply with all non-point
source regul Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature' — �-. Date 07-02-2018 Issued by:Kire Dunbar
Data:07/02/2018
O R-BUILDER ECLARATI0
I hereb ffirm in exempt from the Contractor's License Law for one of the RE-ROOFS:
fallowing hasthat sAll roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,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 die work,and the suveture is not intended or offered for inspection.
sale(See.7044,Business&Professions Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07-02-2018
I hereby affirm under penalty of perjury one of the fallowing 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 too by Section 3700 of the Labor Code,fmthe
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 rend 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 complhmce with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store o•handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment o•devices which emit hazardous
Worker's Com tion laws of California,If,after making this certificate of air contaminants as defined by the 13ay Ar Air Quality Management Dish9ct 1
pensa g will maintain compliance with the Perth Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisleus of the the Health&Safety
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Dale:07-02-2018
I certify that I have read this application and state that the above information is C NS i .TI G AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there s a constructiol lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this p mit is issued(S c.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.
Licensed
Signature Date 07-02-2018 Professional