B-2016-2001 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2001
19864 WHEATON DR CUPERTINO,CA 95014-2362(316 21 085) CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: PRABHU JAIDEV AND KAMATH DEEPAM DATE ISSUED:05/23/2016
OWNER'S PHONE:408-250-2033 PHONE NO:(408)217-8876
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10.C-46 Lic.#910849
Contractor CLEAN SOLAR INC Date 02/28/2018 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:
(N) 12-PANEL ROOF-MOUNTED PV SYSTEM(3.78KW)
I hereby affirm under penalty of perjury one of the following two 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
6yperformance 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
permit is issued. Sq.Ft Floor Area: Valuation:$15750.00
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 ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31621 085
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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLS INSPECTION.
Signature 2006��� Date 5/23/2016 Issued by:Alex Vallelunga
Date:05/23/2016
OWNER-BUILDER DE L RATI
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: .
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
2. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/23/2016
I certify that I have read this application and state that the above information is CONSTRUCTIONLE DI
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending ageW for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 5/23/2016 Licensed
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
Cl1PEFtTINC3 (408)777-3228•FAX(408)777-3333•building(a)cupertino.org
PROJECT ADDRESS } n ( �IAPN#
1 tL/ r -1 lJ VJ
OWNER NAME PHO 2:S6- 2-03-3E-MAIL �_ �, I6 k J(2 / J CL I CAL,
STREETADDRESS n v �+ CITYff6E,ZIP,` ^ FAX ((y� t�
CONTACT NAME
t ►CEJ ` -,e-5
e5 PHO l� 21 � E-MAIL �LQ_
STREET ADDRESS I Zvi I C(r' 1 / CITY,STATE,ZIP �A _�IJCYP C." ' �I � � L,�&- j2J6_q5_75
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT '❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 0[ed LICENSE NUMBER �jj/ 1O/l LICENSE TYPE U�Zz BUS.LIC#Jy/
.COMPANY NAME l E-MAIL !((J U^( r^ v v C jVq
STREET ADDRESS ) Cir 5�. IM I CITY,STATE,ZIP l%NY 1 l P � ✓V���o
ARCHITECTIENGINEER NAME ✓ LICENSE NUMBER (� BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF [f_.SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes LkNO FLOOD ZONE ❑ Yes NO
SOLAR PANELS FOELICTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: KILOWATTS(COMMERCIAL ONLY: AA TOTAL VALUA N: �I
DESCRIPTION OF WORK �/�,y pO j,2
ro,,,/�� �a
r �10 1 (� L
RECEIVED BY
a F: .
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 owner's behalf. I have read this
application and the infonnation 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 byildisg construction. I autho presentatives of Cupertino to enter the above-identifipp prop rty for inspection purposes.
Signature of Applicant/Agent: Dater �{ Q
SUPPLEMENTAL INFORMA IO RE IRED OFFICE'USEONY
OVER-THE-COUNTER -
E D EXPRESS
STANDARD
a
a
of ❑ MAJOR'
PVApp_2011.doc revised 03/16/11
SMOKE / CARBON M X�� �L RM
=S, OWNED` CERI IFICATE OF COMPLIANCE. FILE
hiK4UNIrrY CDE ELOPMENT L FPAR`1T,4ENT-BUIL DINGDIVIS
CUPS 103GO TORREE-AVENUE up.F-RTmo,CA 95014'-3255 1
t F i033= u1tdin , #In :�rc
t �snit a.
.tl e o e Vof A- 1-Aft,g 6k-e: xLo�a Ic�no cr e: 9
E XOT tEFALEDNVD' IPI > ITl -M
. CATE
H�JSAIET-i MW
AN 21121UUU�T, THE,0�Iffi
rMPOSE
its affidavit is a self-certification for the instaUat:iory of all requLredSmoke-and C.'arbon lonoxide, ai s foTi
compliance itl-.2013 CRC SectionR314,2013' QBC Secti n-o 42U and;` 07.211. .wbere no int ricin iocess fir
`mpections are required,
GIi��mrut INMRNumoN
.sting single-family wad milt -family dwelling—s—s1 1T be provided with,S ole J im ,-m Carbon
;Uorioxidg alamxs Tett the w-Auatibn of uddit o'nS,ait�r�[y rs.,�+i repairs to existing d%renin units exceeds
$1000-00,OIC Section 8314 and C13 Secti6ris 907, .11.5 and 4.20.6 rjequirp that SinokeAlarmsand/or Carbon
ionci ide Alarms be stalfed-ii-the following locations
AREA MOU-AI.A)RM-
ALARM
Outside of eac_li-eparate skep mg area in the immediate vicinity cif the
��Irt��aa3`s
n e g lei-el f a div ling 0M hyduCti Imsert e is 5;"
I'ti�—dri each sl pint 'rooirt
Carbon Mo oxide alarm axe raot required i dive! n s appliar ces andthat
do not hay-- ani attached garage, Ca—bon rtto oxide alai co biped,.N th.smoke alarms shall comply Nvitl°
CBC Section 420.6 and shall be_approved �T'tlie Office cif the$fiat-e F re A4,ar h'
er. p x ,lxt d reli ':-unitath no co rxt i tial po��er pPl F,a may b� stalely.batt+_r operated.
faras are permitted t he solely battery operated W-here-ropairs r altetat on d
not result in the removal of Nvall and,ceiling finishes or there is no accessby means of arc,basement or.crawl
space,Refer to CRC Se tiort 8314 m-id CBC Settions 9 .22-IL 2d 0.6.1 An electrical perrnit is required fpr
alanns ivl-Cich.ukusf be con-mected to the builduffig wi nig.
As m er of the above=a fere ced properh.- Thereky certify that the aria( ref6reliced abov-e--hastl ave been.
immalled in accordance with the man acturer"s in tfuctioris and ir-k co pl a ce.ivith the aliforrtia Building
ax-id Calif otnia Residential Co&�-ThI alavin,s havo, peen tested and are pperation-al,as of the date,signed
1�eica�v>
,heve m br3dROO to rn I ttrit #� erri�s r�tf er Mfr" r orf Ibis Statement
a�
, Signature........ ...... _. --- .,.,..,...a,.d�k�. :,a;.=., ....,...
• r
WATER-CONSERVING PLUMBING FIXTURES RUE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTI O 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
/ g (40 )777-3228-FAX(408),777-33'$31-building(&t:ugertino.org
Owner Name �Gt G�u _ _ Permit No: �D�611 �00 I
Address `��I M_ . Uie- Onr: lg�� ;� C S-01 y
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form,and sign bottom of form.
XR No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation.of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 11:01.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division:
Skip the rest of the form and sign bottom of form,
'Z'No Cao to Question 3.
3. Is water service permanently disconnected for your building?
Q Yes Civil Code Sections 1101.1 through 1101.8 do not.apply. Skip the:rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 110 1.1 through 1101 I.S.do not apply. Skip the rest of the form and sign bottom of form.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form:.
5. P.Jease check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4. -
On and after January 1, 2014,building alterations or improvenients shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving 'plumbing fixtures (regardless of whether
property undergoes alterations or improvements),
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or.improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced withwater-
conserving plumbing fixtures throughout the building(regardless of whether,property undergoes alterations or
improvements), _.
❑ My property is a commercial real property. See Civil Code Section 1110 1,5.
On and after January 1,2014,specified building alterations or improvements shall require non=compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures..
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements),
1,as the owner or owner's agent of this property,certify under;penalty-of perjury.that non=compliant plumbing fixtures will be '
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
{ through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as.indicated in the
table on the following page. .-
Owner'or Owner Agent's Signature: Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126113