B-2018-0839 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0839
10577 LA RUDA DR CUPERTINO,CA 95014-4430(369 33 025) BAY AREA SOLAR
SOLUTIONS INC
PLEASANTON,CA
94588
OWNER'SNAME: DATE ISSUED:05/16/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lie.#928652
Contractor BAY AREA SOLAR SOLUTIONS INC Date 02!28/2019 X BLDG ELECT_PLUMH
1 hereb af17 rm that I nm licensed under the f Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
y I provisions o p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)15-PANEL ROOF MOUNTED PV SYSTEM(4.95 kW)
I hereby affirm under penalty of perJw•y one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-lime 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.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$16315.00
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 AIN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 33 025
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 PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature`) Date5/16/2018 Issued by:Jasmine Archbold
Date:OS16 2018
OWNER-BUILDER DECLARATION
I hereby affirm that I nm exempt Pram the Contractor's License Law Ibr one.1 the RE-ROOFS
following two reasons: All roofs..shall be inspected prior to uny roofing material being installed.If it roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and die structure is not intended or offered for inspection.
sale(Sec.7o44,Business&Professions Code)
1. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(See.7044,Business&Professions Cade), Date:5/16/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTERr. 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 fur 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 materiots requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this Calil'ornI.Health&Safety Code,Sections 25505,25533,and 25534.I will
Permit is issued. m aintain 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(x)should 1 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 hvhich craft hazer x
Worker's Compensation laws of California,If,after making this cerlificale of air contaminants ns defined by the Bay Area Air QuaBty Management District i
will maintain compliance with the Cupertino Municipal Code,Clmpter 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:
APPLICANTCERTIFICATION Date:5 2
I certify that I have read this application and ,at.
that the above information is CONS'T'RUCTION 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 AItCHI'ft?C'I"S DEL'LARATION
code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 5/1612018 Licensed
Professional