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151000031126 HOLLYHEAD LN 15100003 ju FAR IM 1171 1 SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1126 HOLLYHEAD LN OWNER'S NAME: RAMACHANDRAN KARTHIK & NARASIMHAN CONTRACTOR: SUN WORK RENEWABLE I PERMIT NO: 15100003 ENERGY PROJECTS 477 VALLEY WAY I DATE ISSUED: 10/01/2015 OWNER'S PHONE: 4084645288 1 MILPITAS, CA 95035 1 PHONE NO: (650) 520 -9918 LICENSED CONTRACTOR'S DECLARATION License Class c-`Cf- C Lie. # ?q-0,7 *i Z- Contractor Date uOr(� /1' 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: t. 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. nz. 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 permit is issued. 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 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 sav-� indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature �_- 17--le Date )0/ / //j ❑ OWNER - BUILDER DECLARATION I ereby affirm that I am exempt train the Contractor's License Law for one of the following two reasons: 1. 1, 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 (See.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Scc.7044, Business & Professions Code). I hereby affirm tinder penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. s. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall he deemed revoked. 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 acid 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, costs, mid expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL 18 ROOF TOP, FLUSH MOUNTED PV MODULES @ 4.3KW Sq. IT Floor Area: I Valuation: $10000 APN Number: 36226027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM aAi7 ['AT.T INSPECTION. Date: ` () // RE- ROOFS: 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. Signature of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements tinder Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner m• authorized agent: l�L,. :e.—. 1. 10 e Date: I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO. CA 95014 -3255 A mks: (408) 777 -3228 • FAX (408) 777 -3333 • building(cl)cupetno.org � S- 100003 PROJECT ADDRESS // Z-. C. i iloc c, y /��(o APN ff :5 ,� r/ %• Q ^J i rO G- C.�ro Cam. N. OWNER NAME y-rt� PHONE �LO�a Ni!1C —! dl`6�—SLSE KFFKY'.... ✓"f. �A' /100. Ln STREET ADDRESS II 26 � / -0LC.- c( /.fr�0 CITY, STATE, ZIP G//P.E2Yiva FAX 4 /UF_ i CONTACT NAME 'eyo -Y/4i✓ /ior-L PHONE— A �7 ` O E-MAIL STREET ADDRESS T 7 T [/w9 y WHY CITY, STATE, ZIP Im-ptie FAX c o I r _ El OWNER ❑ OWNER - BUDDER ❑ OWNERAGENT }s' 4.CONIRACTOR ❑ CONPRACTORAGENC ❑ ARCHTIECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSETYPE BUS. LIC9 A/Nk -OmAC' Rk',NRw QGC EN 6 2o�EC. Z.P732 G --�(.� COMPANY NAME Slin/uoeK E -MAIL FAX STREET ADDRESS q--7-7 (/4GCLY D✓qY CITY, STATE, ZIP I N11L- P17A1, G 4 950�_K PHONE �Z11 C/ ARCFDTECT&NGrNEER NAME LICENSE NUMBER BUS. LTC . COMPANY NAME T &MAIL FAX I STREET ADDRESS CITY, STATE, ZIP PHONE USE OF e ❑ SFD or Duplex ❑ Multi- Farnily PROJECT IN WILDLAND PROJECT IN-- __•_ -• -_w STRUCTURE: ❑ COrmerCICial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONF. ❑ Yes ❑ No - W.,SOLAR PANELS El ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FORSOLARPANELS.• NUMBEROFPANELSNMTS: tb7 KILOWATTS (COMMERCIAL ONLY): Q„� 3 �W TOTAL VALUATION;$ /0/ 61 ,10 DESCRIPTION OF WORK - P-OQC ^OV® T PV S "v�.R�e.•— PANELS': /S �f:9%CW x�- v By my signature below, I certify to each of the following: lam the property owner or authorized agent to a m er' ghat have read this application and the information I have provided is correct. I have read the Description of Work atld veri it is a e. I a o cc p1 with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -id roperty for inspection purposes. S ignature, of Applicant/Agent: A, 4 ftnc,e Date: ieaz /.0 SUPPLE1\4ENTAL INFOR- MATION REQUIRED Q *��T z� ,rOj�213F�COy[�•TER -. "r��,n. �� FZv ayv 5zy"' fi Z'K -�'- ...iARGE$s �} '�'ti " p -�m PM4pp_201 Ldoe revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION JAFDRESS: 1126 HOLLYHEAD LN DATE: 10/01/2015 APN: 362 26 027 BP #: REVIEWED BY: MELISSA VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD Or Duplex USE: p Elec. Permit Pee. PENTAMATION PERMIT TYPE: SOLAR -RE WORK INSTALL 18 ROOF TOP FLUSH MOUNTED PV MODULES a 4.3kW SCOPE phimb. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, ete.). These fees are based on the Preliminary information available and are only an estimate. Contact the Debt for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eft' 7/1/132 Mech. Plan Check plumb. Plan Chock klec Plan Check Meelr_ Perron/ Foe; plumb. Permit Fee: Elec. Permit Pee. Other dlech. Inap- 0(her Plumb /net.. Other lilac. Insy:.. 11(,c . Imp. Fee: phimb. Insp. Fee. Etec. 17sp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, ete.). These fees are based on the Preliminary information available and are only an estimate. Contact the Debt for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eft' 7/1/132 FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 # Alternative Energy System $236.00 1PHOTOVRES Photovoltaic System A Suppl. PC Fee: (D Reg. 0 OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.(j) Reg. Q OT 0 /hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 G Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure i Travel Dorictnentalion Fees: Strong Motion Fee: 1eSEISMICR $1.30 Select an Administrative Item Bldg Std s Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.30 $236.001 TOTAL FEE: $238.30 Revised: 07/02/2015