15080077CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21869 DOLORES AVE
CONTRACTOR: REC SOLAR, INC.
PERMIT NO: 15080077
OWNER'S NAME: RADHAKRISHNA CHAGANTI V AND IVATU
775 FIERO LN STE 200
DATE ISSUED: 08/10/2015
OWNER'S PHONE: 4082188776
SAN LUIS OBISPO, CA 93401
PHONE NO: (888)657-6527
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
License Class �"�((7 rr �
"I
INSTALL ROOF TOP, FLUSH MOUNTED 24 PV MODULES
b Li,. #
(6.6
v
Contractor /3 ate
DLIC
KW) & ADD (N)100 AMP SUB PANEL
I he 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: $13800
7hrformance of the work for which this permit is issued.
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.
APN Number: 35714074.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
_
ek /
granting of this permit. Additionally, the applicant understands and will comply
—Date:
with all non-point sourc egulations per the Cupertino Municipal Code, Sec '
9.18.
Si
RE-ROOFS:
ure 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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
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,
Business & Professions Code)
I, 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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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, Secti s 25505, 25533 d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or author', t. ate:
-
I 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
.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
CITY OF CUPERTINO
FEE ESTIMATOR - nun.nmr. nTVTC110N
AWE 1 his estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District ote-L Those Fooc aro havod nn fho --;1"h1. nerd Orn -h, n aofiss.nfo r nfnnf A. 71 fn: ndilsa �l info
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
21869 DOLORES AVE
DATE: 08/10/2016
REVIEWED BY: MELISSA
11alADDRESS:
APN: 35714 074
BP#:
"VALUATION: 1$13,800
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
INSTALL ROOF TOP FLUSH MOUNTED 24 PV MODULES 6.6 k & INSTALL N 100 AMP SUB
SCOPE
PANEL
AWE 1 his estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District ote-L Those Fooc aro havod nn fho --;1"h1. nerd Orn -h, n aofiss.nfo r nfnnf A. 71 fn: ndilsa �l info
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
1PHOTOVRES I Photovoltaic System
Suppl. PC Fee: (j) Reg. 0 OT
0.0
I hrs
$0.00
PME Plan Check:
$0.00
100 1 amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction uctioil .l a :
T__1
Administrative Fee: ]ADMIN
$45.00
Q
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong? Motion. .Fee: IBSEISMICR
$1.79
1
Select an Administrative Item
Bldp- Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:=
$143.79
$284.00
s To�LTEE—',$427.79
Revised: 07/02t2015