B-2018-1276 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1276
10544 JOHNSON AVE CUPERTINO,CA 95014-3816(375 28 036) PROVOLTZ INC
CAMPBELL,CA 95008
OWNER'S NAME:NIU CHUNLEI AND ZHANG MLAO DATE ISSUED:07/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lie.#9].E2QZ
Contractor PROVOLTZ INC Date 11130/2018 X BLDG_ELECT_PLUMB
I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —MECD 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:
)
I hereby affirm under penalty of perjury one ol'tlre following two decorations: (N)10-PANEL ROOF MOUNTED PV SYSTEM-(3.27 KW
t. 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,for the
performance of the work for which this permit is issued,
is issued Sq.Ft Floor Area: Valuation:$16600.00
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 slate laws relating to building construction,and hereby authorize 37528 036
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 comply with all non-point
source
Issued by:Jasmine Archbold
Date:07/30/2018
OWNER-QDILDEIi DECLARATION
I hereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons; All roof's shall be inspected prior to any roofing material being installed.He roof is
1. 1,as owner of the property,or my craployces,with wages as their sole irstalled without first obtaining an inspection,I agree to remove all new materials for
compensntion,will do the work,and the snveture is not intended or offered for uaspection.
sale(See.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofAppIi.ano
contractors to construct the project(Sec.7044,Business&Professions Code), Date:07/30/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
h. 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 Cade,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 regniremen[s ander Chapter 6.95 of the
Section 3700 of the LabotCorte,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is Issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the wok for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ anterial.Additionally,should I use equipment or devices which craft hazardous
y any person in say manner so as m become subject to the comandamus as defined by rhe Bay Area Air Quality Management District I
Worker's Compensation laws of California..If,after making this certificate of will maintain compliance with
Lobor Code,I must forthwith comply with such provisions or this perrait shall
be deemed revoked Owner or authorized agent: -
APPLICANT CERTIFICATION Data:07130/2018
1 certify that I have read this application and state that the above information Is CONSTRUCTION LENDINGAGENCY
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
Date 07/3012018
Professional