B-2018-0025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0025
7803 HOLLINGER RD CUPERTINO,CA 95014(359 22 085) TESLA ENERGY
OPERATIONS,INC.
SAN MATEO,CA 94402
OWNER'S NAME: DATE ISSUED;01/29/2018
OWNER'S PHONE: PHONE NO:(650)963.5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#8881
Contractor TESLA ENERGY OPERATIONS,INC.Date 1 2/3112 01 8 XBLDG XELECT—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)24 PANEL ROOF MOUNTED PV SYSTEM(7.8 KW); 1-(27 KW)
I hereby affirm under penalty of perjury one of the following two declarations: ENERGY STORAGE SYSTEM;(N)125 AMP LOAD CENTER
u I have and will maintain a certificate of consent to self-insure for Worker's REV#1-INSTALL(N)27 KWH ENERGY STORAGE SYSTEM-
Compensation,as provided for by Section 3700 of the Labor Code,for the ISSUED 2/22/2018
performance of the work for which this per mit is issued. REV#2-RELOCATE BATTERY AND POWER WALL-ISSUED
I have and will maintain Worker's Compensation Insurance,as provided for by 3/6/2018
Section 3700 of the Labor Code,for the performance of the work for which this REV#3-RELOCATE LOAD CENTER AND AUTOMATIC REPLAY
Permit is issued. CLOSER TO METER-03/29/2018
APPLICANT CERTIFICATION Sq.Ft Floor Are.,: Valuation:$25984.00
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
and state laws relating to building construction,and hereby authorize APN Number: Occupe ncy'rype:
representatives of this city to enter upon the above mentioned property for 35922 085
Inspection purposes.(We)agree to save Indemnify and keep harmless the
City of Cupertino against liabilities,Judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 03/29/2018
Issued by:Jasmine Archbold
ER- IL ,R DECLARATION Date:Ot/2912018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reosons: RE-ROOFS:
r. 1,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed,Its roof is
compensation,will do the work,and the structure is not intended or offered fm installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
2. I,as owner ofthe property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signahnc ofApplicant:
1 hereby affirm under penalty of perjury one of the following three declarations: Data:03/29/2018
n. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
performance of the work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,.,,it 25534.1 will
n. I certify that in the performance of the work for which this penuit is issued,Im aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner so re to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California If,after making this certificate of material.Additionally,should I use equipment or devices which emit hazardous
exemption,I become subject to the Worker's Compensation provisions
ions of the air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code,I must forthwith comply with such provisions or(his permit shall will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked, the health&Sorely Code,Sections 25505,25533,and 25534.
APPLICANT CERTIFICATION Owner or authorized agent:
I certify that I have reed this application and state that the above information is Date:0312912018
correct.I agree to comply with all city and county ordinances and state laws CON
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is aconstruction lending agency for the performance
to enter upon the above mentioned property for Inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Civ C.)
to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City In
consequence of the granting of this permit.Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 03/29/2018
Licensed
Professional