B-2018-0559 (3) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0559
22356 RANCHO VENTURA ST APT CUPERTINO,CA 95014-2736(357 03 055) CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:04/05/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#910849
Contractor CLEAN SOLAR INC Date 02/29/2020 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:
INSTALL(N)POWERWALL TESLA WITH INTEGRATED INVERTERS
I hereby affirm under penalty of perjury one of the following two declarations: AND AN AUTOMATIC DISCONNECT SWITCH
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:$7501.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon 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 357 03 055
representatives of this city to enter upon the above mentioned property for
Inspection purposes.(We)agree to save Inde nify an ?flng
harmless the
City of Cupertino against liabilitles,judgments,costs,and =ass
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againV as d City In consequence of the granf this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
AdditiJe
pile tit understands and will comply wnon-point
sourcs p the Cape o M t .'Code, 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt fr m ds ontractor'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 Ute property,or my employees with wages as their sole installed without fast 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(Sce.7044,Business&Professions Code)
x. 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:4/512018
I hereby affirm tinder 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
1. 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 tate
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532( mdd I store oc,1ta'die hazardous
shall not employ any person in any maturer so as to become subject to the material.Additionally,should I use a Pura t or devices wh2' emit hazardous
air contaminants a4cotruction
the B Area Air Quality Matra men[District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compthe C pertin Municipal Code, hapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the HealtCode Seed s 25505,25533,a 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authoriz
APPLICANT CERTIFICATION Date: 1512018
I certify that I have read this application and state that the above Information is ' GECcorrect.I agree to comply with all city and county ordinances and state laws I hereby affirm thatco: truction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which 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. I understand my plans shall be used as public records.
SignatureDate 4/512018 Licensed
Professional