B-2018-0955 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0955
19905 FIG TREE CT CUPERTINO,CA 95014-2314(316 30 078) 1 ST LIGHT ENERGY
INC
MANTECA,CA 95336
OWNER'S NAME:CASELLA RONALD I AND MARY ANNE TRUSTEE DATE ISSUED:07/05/2018
OWNER'S PHONE: PHONE NO:(209)824-5500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C10 C46 Lic.#921371
Contractor IST LIGHT ENERGY INC Date 09/30/2018 X BLDG_ELECT_PLUMB
I hereby affirm that 1 nro licensed render 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)16-PANEL ROOF MOUNTED PV SYSTEM-(4.68 KW)
1 hereby affirm under penalty of perjury one of the fallowing two deelarat rum
^
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:$16000.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale 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 31630 078
representatives of this city to enter upon the above mentioned properly 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 comply with all non-point
source regulations Ike the Chet upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ��„// �^-JJ/��� Date 07105-2018 Issued by:Kim Dunbar
Date:07/05/2018
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 roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I awce to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z. 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:07/05-2018
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 mrd will maintain a Certificate ofCouseut to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
pert rmancc ofthe 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 fire 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
3. I certify[lint in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hnrnrdous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Ah-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 If"" &Safety Code,Se.rlfii s 25505,25533,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:07105-2018
I certify that I have read this application and slate that the above information is CONSTRUCTION
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.
Licensed
Signature - Date 07/05-2018
Professional