B-2018-1211 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1211
21571 COLUMBUS AVE CUPERTINO,CA 95014-4782(356 18 027) SUNPOWER
CORPORATION
SYSTEMS
RICHMOND,CA 94804
OWNER'S NAME:Hsu Ying-ying DATE ISSUED:07/17/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C10,046 Lic.#890895
Contractor SUNPOWER CORPORATION SYSTEMS Date 02/2812019 X BLDG X 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 snit that my
license is in fall force and effect. SOB DESCRIPTION:
(N)16-PANEL ROOF MOUNTED PV SYSTEM-(5.6 KW);ADD
I hereby affnrin under penalty of perjury one of the fallowing two declarations: SUBPANEL-(100 AMP)
r. 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.
I have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Veronica;$10000.00
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 356 18 027
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 s id City inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,t li I understands and will comply with all non-point
source
Data 07117/2018 Issued by:Jasmine At
Data:07/17/2018
-BUILD' DECLARATION
I he eby nfiirm tlra I am exempt from the Contractor's License Law for one of the RE-ROOFS:
follo�'ng two rens ns; All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. r of the property,or my employees with wages as their .In installed without first obtaining an inspection,1 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&Rrofessions Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sea 7044,Business&Professions Code), Datc:07/17/2018
I hereby affirm under penalty of perjury one of the following three deelnrations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 25534.1 will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I health&Safety Code,Section 25532(n)should 1 store or handle hazardous
shall not employ any person in any manner se as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
alr contaminants as defined by the Bay Area it Quality Management District I
Worker's Compensation laws of California. If,ager making this certificate of will maintain compliance with fit @rq"'thio timid a 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 there is a onstruct on lending agency for the performance
relating to building construction,and hereby authorize representatives of this city Of work's for which this permit i ssu (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 MunicipalAECIDTECq"S DECLARATION
Code,Section 9.18. understand my plans shall be used as public records.
Licensed
Signature Data 07/1712018 Professional