The URL can be used to link to this page

15070159f/I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1574 JAMESTOWN DR CONTRACTOR: BALUSU MADHAVI AND PERMIT NO: 15070159 PRASAD OWNER'S NAME: BALUSU MADHAVI AND PRASAD 1574 JAMESTOWN DR DATE ISSUED: 07/22/2015 OWNER'S PHONE: 4084222600 CUPERTINO, CA 95014-5313 PHONE NO ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] INSTALL NEW SOLAR MOUNTED - 20 PANELS (5.20KW) License Class Lic. # AND INSTALL NEW 200 AMP MAIN PANEL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions _ Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $30000 performance of the work for which this permit is issued. I 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 APN Number: 36610072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D YS FROM LAST CALLED INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ' �(� A granting of this permit. Additionally, the applicant understands and will comply Issued by: 'v U`^� Date: V'v� with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, siness & Professions Code) rB as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 2 �' p it is issued. certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date_7 , 2, ) u ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 15D /0I 6( (408) 777-3228 • FAX (408) 777-3333 • building a(_cuoertino.org V6(J PROJECT ADDRESS O �7�I �dlp%71!/fy (�%'M1ll� dt�lil%� Lc -e OWNERNAME r j! yp�� PHONE v� `j ? 2- 2•-G �' G E `��.•i ��'j � 2-L�y C� ^7,�{ � i'��'"t-1 e- `(,Z j}tq I�S�' •� �;�'i�i' c-• _ STREET ADDRESS 1574 CITY, STATE, ZIP FAX 1 Lz CONTACT NAME(PJ}/ fj p PHOTS JJ l E-MAIL lo�& STREET ADDRESSCITY, f574: 'jjcf "� STATE, ZIP e n ��t7i'�' FAX m4,. o l, �7 �7C .5�-OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMIE LICENSEN"jWBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUA4BER BUS. LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA E3Yes )a, NO FLOOD ZONE ElYes [D�NO I�SOLARPANELS ❑ ELECTRIC VEHICLE CHARGING STATION FOSOLAR1ieATERHEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK %f/ � .�.tll .�'U �>�i'=Y l)Gr J f � � � � T •� %.rte-t,E�%� ' � �,� Q �6/ 1. 3,10 23 ....r`: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o6er's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to budding construe ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. �� SisnatureofApplicant/Agent:/(,i4-�1.,�� Date: SUt LEIvIENTAL INTFORMATION REQUIRED l3�''u� 4 � OTlE12„TI3�C01;iI�,}'ER �� 490 SS 1 - 3 Z . . . tA:TASDR PV4pp_2011.doc revised 03/16111 c/1 CITY OF CUPERTINO B et4o f S9 . FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l iso. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) 1574 JAMESTOWN DATE: 07/22/2015 REVIEWED BY: PAUL IlaADDRESS: APN:. 3661 072 BP#: *VALUATION: 1$30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex Phallb. hisp. Fee: PENTAMATION PERMIT TYPE:' SOLAR -RE WORK Install new solar mounted - 20 Panels 5.20 and Install new 200 Amp Main Panel SCOPE 200amps $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l iso. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) 1h,ch. Plum Check Phu;rb. Plary Check Elec. Plan Check TTOThrs $0.00 :bleep. Permit Fite: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other ,l /cch. Insp. Other Plumb Insp. Other Elea Insp. Lodhrs $48.00 Alach. Insp. Fire: Phallb. hisp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l iso. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $236.00 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: � Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 200amps $48.00 Electrical / IBELEC200 Services Permit Fee: $0.00 Suppl. Insp. Fee -C) Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 0 G Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 10 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.0 SUBTOTALS..; $146.90 $284.00 = TOTiL FEE $430.90 Revised: 07/02/2015 FI