B-2018-1289 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:3-2018-1289
1135 SCOTLAND DR CUPERTINO,CA 95014-5060(362 26 056) HOME NETWORKS,
ELECTRIC&SOLAR
SAN JOSE,CA 95131
OWNER'SNAME:GUPTA RAJEEV AND REETA TRUSTEE&ETAL DATE ISSUED:07/31/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lie.#820184
Contractor HOME NETWORKS ELECTRIC&SOLAR Data 05131/2019 X BLDG X ELECT—PLUMB
I herebyaffirm that 1 am licensed under the _MECII X RESIDENTIAL_COMMERCIAL
� provisions nl'Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)EV CHARGING STATION-(50 AMP);
I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE MAIN PANEL-(200 AMP)
u I have and will maintain a certificate of cmtscut to self-insure for Worker's
Compensation,as provided£or by Section 3700 of the Labor Code,for(he
peiform..as of the work for which this permit is issued.
I have read this application and state ICthat 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 362 26 056
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
I hereby affirm that 1 am exempt from the Contractor's License Law for one at the RE-ROOFS,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner ofthe 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 the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Cade)
2. f,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicano
contractors to construct the project(See.7044,Business or Professions Code), Date:07/31/2018
1 heathy affirm under penalty arperjury one of the following three declarations: ALL ROOK COVERINGS TO BE CLASS"A"OR BETTER
I, I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the liaznrdous materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Suctions 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Code,Section 25532(.)should I store or handle hazardous
shall not employ any person in any manner so as to become subject m the material.Additionally,should 1 use equipment or devices which emit hazardous
air conlomiumus es defined by the tiny Area Air 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 Health&Softly 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be cieented revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/31/2018
I certify that I have read this application and state that the above Information is EONS'1'RUCTION 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.
Signature Date 07131/2018 Licensed
Professional