B-2018-0134 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0134
21064 MARCY CT CUPERTINO, CA 95014-1658 (326 54 030) TESLA ENERGY
OPERATIONS, INC.
FREMONT, CA 94555
OWNER'S NAME: DATE ISSUED: 02/02/2018
OWNER'S PHONE: PHONE NO: (844) 837-5201
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C10.C46 Lic. #888104
Contractor TESLA ENERGY OPERATIONS, INC. Date 12/31/2018 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:
I hereby affirm under penalty of perjury`one of the following two declarations: (N) 16-PANEL ROOF MOUNTED PV SYSTEM (5.2 KW); INSTALL (N)ENERGY STORAGE SYSTEM (13.5 KW)
I have and will maintain a certificate of consent to self-insure for Worker'sREV #1 - ADD (1) ADDITIONAL PV PANEL (NOW 17-PANEL ROOF
Compensation, as provided for by Section 3700 of the Labor Code, for the MOUNTED PV SYSTEM); RELOCATE PV PANELS; UPDATED
performance of the work for which this permit is issued. PW/INVERTER LOCATION TO BE INSIDE; INSTALL (2) SUBPANELS
I have and will maintain Worker's Compensation Insurance, as provided for by (200 AMPS EACH); INSTALL NEW MAIN PANEL (125 AMPS)
Section 3700 of the Labor Code, for the performance of the work for which this -ISSUED 12/14/18
permit is issued.
APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $11544.00
1 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 326 54 030
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 WORD IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the app, icant understands and will comply with all non-point WI'T'HIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations �br the Cup Cho Municipal Code, Section 9.18. 10 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12/14/18
Issued. by: Kiln Dunbar
Date: 02/02/2018
OWNER-BUILDER DECLARATION
I hereby affirm that 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. 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. 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: 12/14/18
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 theerformance of the work for which this
p 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 or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, S , ions 25505, 25533, and 25534.
be deemed revoked. ��
®caner or authorized agent:
APPLICANT CERTIFICATION Date: 12/14/18
I certify that I have read this application and state that the above information is CONSTRUCTION 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 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 12/14/18 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0134
21064 MARCY CT CUPERTINO, CA 95014-1658 (326 54 030) TESLA ENERGY
OPERATIONS, INC.
FREMONT, CA 94555
OWNER'S NAME: DATE ISSUED: 02/02/2018
OWNER'S PHONE: PHONE NO: (844) 837-5201
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10. Lic. #888104
Contractor TESLA ENERGY OPERATIONS INC Date 12/31/2018 X BLDG X ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _
ME,CH 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) 16-PANEL ROOF MOUNTED PV SYSTEM (5.2 KW); INSTALL (N)
I hereby affirm under penalty of perjury one of the following two declarations. ENERGY STORAGE SYSTEM (13.5 KW)
1. I have and will maintain a certificate of consent to self-insure for Worker REV#1 - UPDATED PW/INVERTER LOCATION TO BE INSIDE;
Compensation, as provided for by Section 3700 of the Labor Code, for the RELOCATE PV PANELS; INSTALL (2) SUBPANELS (200 AMPS
performance of the work for which this permit is issued. EACH); INSTALL NEW MAIN PANEL (125 AMPS)
2. I 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 Floor Area: Valuation: $11544.00
APPLICANT CERTIFICATION
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 326 54 030
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
Additionally, the applicant understands and will comply with all non-point PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature , Date 12/04/2018 Issued by: Ki.m Dunbar
Date: 02/02/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I ant 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. 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. 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: 12/04/2018
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. 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
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 contaminants as defined b the Ba Area Air
Worker's Compensation laws of California. If, after: making this certificate of Y Y Quality Management.District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 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: 12/04/2018
certify that I have read this application and state that the above information is CONSTRUCTION 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 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.
Licensed
Signature Date 12/04/2018
Professional