B-2018-1277 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1277
10437 MANZANITA CTCUPER'rl NO,CA 95014-6565(342 61 009) CLEAN SOLAR INC
SAN.LOSE,CA 95112
OWNER'S NAME: DATE ISSUED:07/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CIO Lic.#910849 X BLDG_ELECT_PLUMB
Contractor CLEAN SOLAR INC Date 02/29/2020 —
I 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 fall force and effect. JOB DESCRIPTION:
(N)16 PANEL ROOF MOUNTED PV SYSTEM(5.76 KW)
1:hereby affirm under penalty ofperjtuy one of the following two declarations:
a. 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.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
is issued. Sq.Ft Floor Area: Valuation:$2274700
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 Nn—her: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 61 009
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 underside s and will comply with all non-point
source regulpttat pert e Cu ertl Municipal Code,Section 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Date 7-30-2018 Issued by:Kim Dunbar
Date:07/30/2018
OWNE LBUILDER 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.of is
a. I,as owner of the property,or my employees with wages as their sole instal led 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(S-7044,Business&Professions Code)
z. I,a,owner of the property,am exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code). Date:7-30-2018
I hereby affirm under penalty of perjury one of the following three declarations: At I ROOF 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 of the Labor Code,for the
performance 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 leave read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 arrive Labor Code,for the performance of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9,!2.,.d the
s. I certify that in the performance of the work far which this permit is issued,L Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ any person in any usurer so as to become subject to the material.Additionally,should I use equipment on devices which emit hazardous
air contaminants as calmed by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,atter making this certificate of will maintain comliance
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 thiscity 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 ARCFIITEC'I^S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 7-30-2018
Professional