B-2018-1330 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; CONTRACTOR: PERMIT NO:B-2018-1330
20972 GREENLEAF DR CUPERTINO,CA 95014-1822(326 30 102) TESLA ENERGY
OPERATIONS,INC.
FREMONT,CA 94555
OWNER'S NAME: DATE ISSUED:08/16/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#$$@144
Contractor TESLA ENERGY OPERATIONS INC Date 12/31/2018 X BLDG ELECT_PLUMB
1 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 full force..,it effect. JOB DESCRIPTION;
I hereby affirm under penalty of perjury one of the followhrg'two declarations: (N)26-PANEL ROOF MOUNTED PV SYSTEM(7.93 kW)
1. 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,
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flom Area: Valuation:$11.736.40
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agreeto comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 32630 102
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 IIP WORI{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE 012
Additionally,the applicant understands and will comply with all non-paint
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
I hereby affirm that I am exempt front the Contractor's License Law for one of the RE-ROOTS•
following two reasons: All root's shall be inspected prior to any roofing material being installed.If e roof is
r. 1,as owner of the 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 dre.smncnue is not intended or offered for inspection.
sale(Sec,7044,Business&Professions Code)
z L,as owner of the property,am exclusively contracting with licensed Signature ofApplicana
contractors to construct the project(Sce.7044,Business&Professions Cade). Date:
I hereby affirm under penalty of perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t, I have and will maintain a Corti ,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 far by I have read the hozardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,mid 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Sectiau 25532(.)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws o£California.If,after making this certificate oP will maintain compliance with the Cupertino Municipal Code,Chapter 9.J2 and
exemption,l become subject to the Worker's Compensation provisions of line the health&Safety Code,&
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 Licensed
Professional