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B-2016-1383 PERMIT, APP & FEE ESTCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; CONTRACTOR: PERMIT NO: B-2016-1383 10316 TONlTA WAY CUPERTINO, CA 95014-2932 (359 15 001) (SANTA CRUZ WESTSIDE ELECTRIC INC) SANTA CRUZ, CA 95060 OWNER'S NAME: PALLA SRIDHAR RAND KIRAN MAT TRUSTEE DATE ISSUED; 02/17/2016 OWNER'S PHONE: 408-406-5086 PHONE No: 831-469-9898 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lie. QM294 Contractor ( ANTA CRU7 W ST IDE ELECTRIC INC) Date Q211712016 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the Provisions of Chapter 9 (commencing MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL 17 ROOF TOP, FLUSH MOUNTED PV MODULES (5.1kW) I hereby affirm undo' penalty of perjury one of One following hro declarations; r, 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 Cade, for tlnc performance olds 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 permit is issued. Sq. Ft Floor Area: Valuation: $17850.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 359 15 001 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, and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN l80 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAS l D n CTION. Code, Section 9.118/88.�.tt Issued by: ME AM - Si g nature /N(`'GI/r `{J` Date 02/17l2016 Date: 02/17/2 0 OWNER -BUILDER DECLARATION RE -ROOFS I hereby afthan that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is fallowing two reasons: installed without first obtaining an inspection, I agree to remove all new materials for a. l,as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the stiocture is not intended or offered for sale (See.7044, Business & Professions Code) Signature of Applicant: 2. T, as owner of the property, am exclusively contracting with licensed Date: 02/17/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penally of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS "A" OR BETTER t. 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Corte, for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have rend the hazardous materials requirements under Chapter 6.95 of flee 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Cade, Sections 25505, 25533, and 25534. f will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should 1 store or handle hazardous 3. T certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the nitcontaminants as defined by the Bay Area Air Quality Management District I Wm ker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25173, a,(nd/25534. exemption, 1 become subject to the Worker's Compensation provisions of the 7 Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized be deemed revoked. agent: Date: 02/17/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above Information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Cie C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Signature Date 02/17/2016 Professional CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building ancuoertino.orc U- 2016 AE - 13s3 PROJECT ADDRESS 10316 Tonita Way APN#N� � Q� OWNER NAME Sridhar Palla PHONE 408-406-5086 E-MAIL STREET ADDRESS 10316 Tonita Way CITY, STATE, ZIP Cupertino, Ca 95014 FAX CONTACT NAME Kristi Cassetta PHONE831-226-9363 E-MAIL kassetta@sandbarse.com STREET ADDRESS 2119 Delaware Avenue CITY, STATE, ZIP Santa Cruz Ca 95060 FAX 831-515-5098 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT I[1 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGRJBER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Sandbar LICENSE NUMBER 846294 LICENSE TYPE C-10 BUS. LIC N 33gy r 4 P `ban Nyeruz Westside Electric dba Sandbar E-MAkcassetta sandbarsc.com FAX 831-515-5098 STREET ADDRESS 2119 Delaware Avenue CITY, STATE, ZIP Santa Cruz Ca 95060 PHONE 831-469-8888 ARCHITECT/ENGINEER NAME Sungevity LICENSE NUMBER BUS. LIC # COMPANYNAME E-MAIL Sam - sholing@sungevity.com PAX STREET ADDRESS66 Franklin Street Ste. 310 CITY. STATE, kland CA 94607 PHONE USE OF W SFD Or Duplex ❑ Multi -Family STRUCTURE : ❑ Commercial PROJECT IN WILDLAAND yy,, URBAN INTERFACE AREA El Yes }y No PROJECT IN FLOOD ZONE ❑ Yes ❑ No Ia SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER. FOR SOLAR PANELS: NUMBER OF PANELSNNITS: t� KILOWATTS(E©MMiYM�Fh MY): e`- J TOTAL VALUATION: Q17,p5O 4' V DESCRIPTION OF WORK photovoltaicInstallation of a 5.1 kw grid tied solar array roof mount RECEIVED By my signature below, I certify to each o he• ollowing: application and the information I hyuEpp-7 ided s copr ordinances and state laws relating io�Kuild' I co st Signature of Applicanf/Agent: �7d/ I am the property owner or authO ge o� er's behaf have read this I have read the Descrip[ioI - Work -and_ 4_ Si_ accura e. I ogre % i l plicable local I authorize representatives of Cupertino to enter the above-i eopert o Ion purposes. _ Data 25/16 SUP�L- � ENTAL INFORMATION REQUIRED OFFICE USE ONLY W -❑ OVER-THE-COUNTER yH ❑ EXPRESS V W ❑ STANDARD z , j ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03116/11 �'"�"'� CITY OF CUPERTINO f" ,. � FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10316 TONITA WAY DATE: 02/1712016 REVIEWED BY: MELISSA APN: 359 15 001 BP#: "VALUATION: 1$17,850 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WoRiC FINSTALL 17 ROOF TOP FLUSH MOUNTED PV MODULES 5.1kW SCOPE St t4i_ Pl"trr Ch, <.`, r' u h Non tite'c 2;t r , n {'hzcF Ucch Per vT Pee_ r r r t, Pz=r:q'' t7r-"II'iCi }t. IN1j7. {I ,'-hliUlPi>IIP5ft tJF e1 [:[:. litktJ. a t, �f:. L tit;. beer i tz+rE-. brs,�. Tyr. sG I gv" ,J- r NOTE. Tltis estimate tloes not include fees tlue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the areliminary information available and are only an evtimate. Cmemet the Drat fnr m/fi,'l :a fo_ FEE ITEMS (Fee Resolution Il-053 Lff 711113J FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $236.00 Alternative Energy System 1PNOTovREs Photovoltaic System Suppl. PC Fee: (D Reg. 0 OT 0.0 This $0.00 PME Plan Check $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes Q) No $0.00 Advanced Planni�Pee: $0.00 Select a Non -Residential Building or Structure Q � 7 Stroll; Motion Fee: IBSBISMICR $2.32 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.32 $236.00 T0TA:L FEE: F $239.32 Revised: 01101 /2016