BLD-2020-2057BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20106 JOHN DR Cupertino
APN: 369 34 024
PERMIT NO: BLD-2020-2057
OWNER'S NAME: QU XIAORONG AND PAN PINGYI
OWNER'S PHONE: Not Provided
JOB DESCRIPTION
INSTALL A ROOF MOUNTED SOLAR SYSTEM (12 MODULES)(4.08
kW); (1) TESLA POWER WALL (13.5 kW); DISTRIBUTION PANEL (225 AMP).
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: TESLA ENERGY OPERATIONS INC
LICENSED CLASS:
C46 SOLAR, B GENERAL BUILDING CONTRACTOR, C10 ELECTRICAL, C39 ROOFING, C36 PLUMBING
LICENSED NO: 888104
EXP DATE:
12/31/2022
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.
I hereby
affirm under penatiy of perjury one of the following three 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 performance of the
work
for which this permit is issued.
V
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.
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
V
with
the Cupertino Municipal Code, Chapter 9.12 and the Health
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment
or devices which emit hazardous air contaminants
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
An EPA Lead -Safe Certified Renovator will be responsible
for this project.
Certified
Firm Name:
Firm Certification No:
V
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby
affirm
under penalty of perjury that there is a construction
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's
Name:
Lender's Address:
APPLICATION 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 and state laws relating to building
construction, and hereby authorize 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, judgements, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature:
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