B-2018-1685CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-1685
10642 FARALLONE DR CUPERTINO, CA 95014-4408 (369 33 043)
SUNWORK
RENEWABLE ENERGY
PROJECTS
MILPITAS, CA 95035
OWNER'S NAME:
DATE ISSUED: 10/04/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-46 Lic. #920732
Contractor SUNWORK RENEWABLE ENERGY PROJECTS Date 08/31/2020
X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
1 hereby affirm that I am licensed under the provisions of 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)12 -PANEL PV SYSTEM - (3.48 KW)
affirm under penalty of perjury one of the following two declarations:
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
(hreby
performance of the work for which this permit is issued.
1 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
Sq. Ft Floor Area:
Valuation: $7500.00
permit is issued.
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:
Occupancy'1'ypc:
building construction, and hereby authorize
and state laws relating�e)
369 33 043
representatives of thisy to a ter upon the above mentioned property for
inspection purposes. ag ee to save indemnify and keep harmless the
City of Cupertino st liabil ies, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai t id City consequence of the granting of this permit.
Additionally, the ca un rstands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulatio r C ertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10/04/2018
Issued by: Jasmine Archbold
Date: 10/04/2018
OW ER-BUI ER DE A
I hereby affir 4that 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 roof is
1. 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 the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/04/2018
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 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 performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino M icipaCode, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) s ouId tore or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use a ip nt or ices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the B Ar Air u lity Management District I
will maintain compliance with the C $ert 0/T un c pal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sect' n 550 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 10/04/2018
1 certify that I have read this application and state that the above information is
CONSTRUCTI N LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a con ruction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is i tsued (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 10/04/2018
Licensed
Professional