B-2018-1828 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1828
10700 CASTINE AVE CUPERTINO, CA 95014-1313 (326 43 033) FREE ENERGY
SYSTEMS INC
SAN FRANCISCO, CA
94104
OWNER'S NAME: DATE ISSUED: 10/24/2018
OWNER'S PHONE: PHONE NO: (800) 804-7958
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO;
License Class SOLAR Lic. #988918
Contractor FREE ENERGY SYSTEMS INC Date 12/31/2019 X BLDG X ELECT — PLUMB
MECH X RESIDENTIAL ' COMMERCIAL
I 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) 26-PANEL ROOF MOUNTED PV SYSTEM - ( 8.58 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV # 1 - ROOF LAYOUT CHANGE - ISSUED 11/08/2018
1. I have and will maintain a certificate of consent to self-insure for Worker's REV # 2 - UPGRADE SUBPANEL SAME LOCATION - (200 AMP) -
pensation, as provided for by Section 3700 of the Labor Code, for the ISSUED 11/15/2018
erformance of the work for which this permit is issued.
is issued. Sq. Ft Floor Area: Valuation: $36465.00
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 Number: Occupancy Type:
326
and state laws relating to building construction, and hereby authorize 326 43 033
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, judgment , and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sai in conseq ince of e granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE 012
Additionally, the ap an derstan - and w comply with all non- o
source regulatio . t1 rr' . 8. 180 DAYS FROM. LAST CALLED INSPECTION,
Signature Date 11/15/2018 Issued by: Jasmine Archbold
Date: 10/24/2018
OWNEI, ILDER DECLARATIO
I he e., y affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
fo wing two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, 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)
z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (See.7044, Business & Professions Code). Date; 11/15/2018
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
N 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. 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 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 Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should. I use equipme t r evices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay ea Air uality Management District I
Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the C , ertino unici al Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health &.
)
to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Nam
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 ARCH:I:TECT'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 11/15/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1828
10700 CASTINE AVE CUPERTINO, CA 95014-1313 (32643 033) FREE ENERGY
SYSTEMS INC
SAN FRANCISCO, CA
94104
OWNER'S NAME: DATE ISSUED: 10/24/2018
OWNER'S PHONE: PHONE NO: (800) 804-7958
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lic. #988918 .
Contractor FREE ENERGY SYSTEMS INC Date 12/31/2019 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 of the Business & Professions Code and that my
license is in full force and effect: JOB DESCRIPTION:
(N) 26-PANEL ROOF MOUNTED PV SYSTEM - ( 8.58 KW)I hereby affirm under penalty of perjury one of the following two declarations: REV #1 - ROOF LAYOUT CHANGE - ISSUED 11/08/2018
I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 32643 033
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 again ities, judgments, costs, and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED
may accrue against
11/08/2018 Issued by: Jastni.ne Archbold
Date: 10/24/2018
N - UILDER DECLARATION
I her y affirm that Lam 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. I, as owner of the property, am exclusively contracting with licensed. Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/08/2018
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. 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 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 Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued' I Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipm devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants. as defined by the Ba rea A' Quality M ement District I
Worker's Compensation laws of California. If, after making this certificate of will maintain compliance
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 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 11/08/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1.828
10700 CASTINE AVE CUPERTINO, CA 95014-1313 (326 43 033) FREE ENERGY
SYSTEMS INC
SAN FRANCISCO, CA
94104
OWNER'S NAME: DATE ISSUED: 10/24/2018
OWNER'S PHONE: PHONE NO: 800 804-7958
LICENSED CONTRACTOR'S .DECLARATION BUILDING PERMIT INFO,
License Class C46 Lic. #988918
Contractor FREE. ENERGY SYSTEMS INC Date .12/31/2019 X BLDG — ELECT — PLUMB
I hereby affirm that I am licensed under the provisions ofChapter 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 and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: (N) 26-PANEL ROOF MOUNTED PV SYSTEM - ( 8.58 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
erformance of the work for which this permit is issued.
is issued.
Sq. Ft Floor Area: Valuation: $36465.00
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: Occupancy Type:
and state laws relating to building construction, and hereby authorize 32643 033
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 PENT EXPIRES IF
may accrue against said Ci onsequence oft ranting of this permit. WORK IS NOT STARTED
Additionally,
10/24/2018 Issued by: Jasmine Archbold
chbold
Date: 10/24/2018
NE ILDER DECLARATTON
I h by affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
lowing two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, 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 (See.7044, Business & Professions Code). Date: 10/24/2018
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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. 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 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 Municipal Code, 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) should I 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_9ces which emit hazardous
Worker's Compensation laws of California. If after makingt air contaminants as defined by the Bay Are -A,ir alit Management '
his certificate of yDistrict I
will maintain compliance with the Cup � nicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety
correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that ther a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city of work's for which t ermit 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 ARCH:.ITECT'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 10/24/2018 Licensed
Professional