B-2018-1321 CITY OF CUPERTINO BUILDING PERMIT
BUILDINCADDRESS: CONTRACTOR: PERMIT NO:B-2018-1321
21837 GARDENVtEW LN CUPERTINO,CA 95014-1131(326 19 085)- CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:08/06/2018
OWNER'S PHONE: PHONE NO:(
LICENSED NTRA "OI DECLARATION BUILDING PERMIT INFO:
License Class C-1 0 Lt.,#910849
Contractor CLEAN SOLAR INC Date 02/29/2020 X BLDG X ELECT—PLUMB
I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —MECII X RESIDENTIAL_COMMERCIAL
with Section 7000)of Divislnn 3 or the Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
(N)18-PANEL ROOF MOUNTED PV SYSTEM-(6.48 KW);(N)
1 hereby affirm under penalty of perjury one of the following two declarations: SUBPANEL-125 AMP);(N)EV CHARGING STATION-(50 AMP)
r, I have and will maintain a certificste of cmtsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for die
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for dic performance of the work for which this
permit is issued. Sy.Ft Floor Area: \+aluatlon:$23500.00
APPLICANT CERTIFICATION
I certify that I have read this appllcallon 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 326 19 085
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 under tands and will comply with all non-point
source
Signatu Date 0 810 6/2 01 8 Issued by:Jasmine Archbold
Date:08/06/2018
B ITION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following five reasons: All roofs shell be inspected prior to any roofing material being installed.If a roof is
r. Las owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the stricture isnot intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
1. I,as owner oldie property,am exclusively contracting with licensed Signature of Applicant
contactors to construct the project(Sec.7044,Business&Professions Code), Date:08/06/2018
f hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO 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 under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performeuce 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. I certify that in the performance of the work for which this permit is issued,I Health&Safety Can Sectlon 25532(0)should I store or handle hazardous
sha(I not employ any person in any manner so as to become subject to die material.Additionally,sboald 1 use equipment or devices which emit hazardous
at,-eontaminants 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 the Cupertino Mmdcip Cuda,Chequer 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the 11 11&Safety
be deemed revoked, Owner or authorized agent•
APPLICANT CERTIFICATION Date:08/06/2018
I certify that I have read this application and state that the above information Is CQNSTfVCTION 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 indemnlfy 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 MunlGipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 0810612018 Licensed
Professional