B-2018-1282 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CON'TRACT'OR: PERMIT NO:B-2018-1282
10421 N PORTALAVE CUPERTINO,CA 95014-2313(316 30 032) SUNPOWER
CORPORATION
SYSTEMS
RICHMOND,CA 94804
OWNER'S NAME: DATE ISSUED:07/31/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Llc.#890895
Contractor EQSEQDER CORPORATION SYSTEMS Date 0 212 812 0 1 9 X BLDG_ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 ofthe Business&Professions Code and that my
license Is in full force Red effect, JOB DESCRIPTION:
I hereby affirm under penalty of perjury one ofthe following two declarations: (N)10-PANEL ROOF MOUNTED PV SYSTEM-(3,60 KW)
1. 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 of the work fid,which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
?' Section 3700 ofthe Labor Code,for the performance ofthe 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: Ocnrpuncy Type:
and state laws relating to building construction,and hereby authorize 316 30 032
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 WORT{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 per the Caper' Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 071311201II Issued by:Jasmine Archbold
Date:07/31/2018
OWNER-BUILDER DECLARATION
1 hereby affirm thet I am exempt from the Contractor's license Law for one of the RE-ROOFS:
following two reasons: All reefs shall be inspected prior many roofing material being installed.If a roof is
t. 1,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered far inspection.
sale(Sec.7044,Business&Proeessions Code)
2. 1,as owner ofthe property,am exclusively contracting with licensed Signahue ofAppiicaue
contractors to construct the praject(Sec.7044,Business&Professions Cade). Date:07/31/2018
I hereby affirm under penalty of perjury one of the following[bran declarations: ALL ROOF COVERiNGS'f0 BE CLASS"A"OR BETTER
r. 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 ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 or the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued.
n maintain compliance with the Cupertino Municipal Cantu,Chapter 9.12 and the
HadNr&Safety Code,Section 25532(a)should 1 store m•handle hazardous
a. I all no that in y a performance of the work for to be this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person In any manner so as to become subject to the air eontumioants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California,If,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,1 become subject to the Worker's Compensation provisions ofthe the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Cede,I must forthwith comply with such provisions or this permit sholl
APPLICANT CERTIFICATION Date:07/31/2018
I certify that I have read this application and slate that the above Information is CONSTRUCTION LENDING AG tCY
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 Ilabillties,
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
Coup,Section 9.18. 1 understand my plans shall be used as public records,
Signature Data 0 713 112 01 8 Licensed
Professional