B-2018-1210 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1210
22119 RAE LN CUPERTINO,CA 95014-4032(356 07 067) SUNPO WER
CORPORATION
SYSTEMS
RICHMOND,CA 94804
OWNER'S NAME:Tiwari Name And Progyn Trustee DATE ISSUED:07/17/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C40 C46.A Lic.#890895
Contractor SUNPOWER CORPORATION SYSTEMS Dale 02/28/2049 X BLDG X ELECT_PLUMB
1 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)11-PANEL ROOF MOUNTED PV SYSTEM-(3.96 KW);(N)
I hereby affirm under penalty of perjury one of the following two declarations: PANEL-(100 AMP)
1. 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,far the
performance 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 Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5000.00
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 15607 067
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 WORT{IS NOT STARTED
may accrue against sat Cityin co sequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,
I hereb at'tirm that I am exempt tYnm the Contractor's License Lav I'or ane of the RE-ROOFS:
following a reason All roof shall be inspected prior to any roofing material being installed.If a mof is
r. 1, owite of the property,or my employees with wages as(hair sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the an torture 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(Sec.7044,Business&Professions Code), Date:07/17/2018
I hereby affirm under penalty of perjury one of the following three declarations; pLL ROOF COVERINGS 7'U 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 mrder Chapter 6.95 of the
Section 3700 of the Labor Cede,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. afnteIn compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance ofthe work for which this permit is issued,I m health&Safety Code,Section 25532(x)should I store or handle hazardous
person shall not employ any peon fn any manner an as to become subject to the material.Additionally,should 1 use equipment or devices which craft hazatitans
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,if,after making this certificate of will maintain compliance with th l9 rtino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safet
the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per is iss ed(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 ARC/IL ECT'S
DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 07!17/2018
Professional