BLD-2023-2766_ApplicationCUPERTINO
(vJ)
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3265
(408)777-3228 • FAX (408) 777.3333 • bujldins@suuaqinp.org
PROJECT ADDRESS l 'J5q4 DA-I-< VIUWI, /�, I APN#
AE
OWNER. NAME w I L--L tvGVt;, rr I PHONE J..tO R • _3otrtr.3.:t-l f!,.'Pt'i:>,u d tfu) J.i) If
Wldl./. tLJY)t
/)A-{,z V fHlEL/-I� I
mll'.l!T ADDRl!SS g)_, 3 .;q -'-I crrv. STATl!.ZlP q50{4 FAX Cupertino CA CONTACT NAME Matt Trout I PHONE (408)289-9725 11!-Mi\lL oermits@willownienelectric.com S1lWlT ADDRESS 3751 Charter Park Court, Ste. D c1rv.sTATE. zip San Jose, CA 95136 FAX (408)289-9725
□ OWNl!R □ OWNER-BUILDER □ OWNER AOEITT W CONTRACTOR 0 CONTRACTOR AGENT □ ARCHITECT D ENGINEER □ DEVl!LOPER 0 TENANT
coNTRA<.."TOR NAME Matt Trout coMPANYNAME Willow Glen Electric, Inc.
STR£ET ADoae.ss 3751 Charter Park Court, Ste. D
ARCHITECT/ENOINl!l!R NAME N/A
COMPANY NAME
STREl!T ADDRESS
USE OF � SFD or Duplex □ Multi-Family
STRUCTURI!: D Commercial
LICENSE NUMBER 591918 I LICENSE TYPE C-10B-MAIL permits@willowglenelectric.com c1rv.sTATl!.z1r San Jose, CA
LICENSE NUMBl!R
E-MAIL
CITY, STATE.ZIP
PROJECT IN WILDLAHD
95136
URBANIHTl!RFACl!ARl!A 0 Yes 0 No
BUS. UC# 400077
FAX ( 408)289-9725PHONE (408)289-9725
BUS.UC#
PAX
PHONE
PROJECT IN FLOODZOHI! O Yes 0 No
0 SOLAR PANELS I fl ELECTRJCVEHICLE CHAROINO STATIOH I □ SOLAR.WATER.HEATING D OTHJ!R:
FOR SOLAR PANJi.LS: NUMBi;R OF PAHlil.S/l.lHITS: KILOWATTS (COMMllRCIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK Electric Vehicle Charaina Circuit:
60A 8V �WU{ �f-
-.J
I Rl!Cl!IVBD BY:
By my signature below, I certify 10 each of the following
�
. I the�r ny owner or authorized agent to act on the propcny owner's behalf. I have read this application and the information I have p���id is co. cl I e read e Dcp:ription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil • c s • op,_,. o • r"""""""iii'irves of CUpcrtino to enter the above-!'j• cntifitl pro,rty for inspection pUIJ>OSCS,
Signature of Applicanl/Agcnt: ,,i:,:;;J f Date: { D l � Z, SUPPLEMENT AL INFORMATION REQtnRED omCE UBI! ONLY
�
0 OVER•TJB.CO,UNTER □£XPIU!SS I 0 STANDARD
� 0 LARGE
0 MAJOR '
E/M Pack: permitcenter@cupertino.org PVApp_201 I.doc revised 03/1611 I