B-2016-2284 CITY OFC PERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2284
10445 BYRNE AVE CUPERTINO,CA 95014-2813(357 12 067) WEST COAST SOLAR
INC
BRENTWOOD,CA
94513
OWNER'S NAME: TELANG PRASHANTH NAND SHENVI SEE R TRUST DATE ISSUED:07/11/2016
OWNER'S PHONE:925-516-3900 PHONE NO:(925)516-3900
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Lic.#9054
9
Contractor WEST COAST SOLAR INC Date 12/31/2017 I X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9i(commencing
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(3.12kW)
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
performance of the work for which this permit is issued.
2. ve 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:$13000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above r
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 357 12 067
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 in consequence 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 CALL + PECTION.
' P
Signature Date 07/11/2016 Issued by:ME-LISS
Date:07/11/2016
0, R-BUILDER DECL ION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 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)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&Professions Code). Date:07/11/2016
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 LaborlCode,for the
performance of the work for which this permit is issued. i 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. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
a. 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 age
APPLICANT CERTIFICATION Date:07/11/2016
I certify that I have read this application and state that the above information is C TRUCTIO LE AGEY
correct.I agree to comply with all city and county ordinances and,jstate laws I hereby affirm that there is a construction lending agency 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 i understand my plans shall be used as public records.
Licensed �
Signature Date 07/11i/2016 professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ig 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX(408) 777-3333• buildinga-cupertino.org
3 V, 20f 22-8
PROJECT ADDRESS /(n (f {5 Sj\ C A p� , /// APN# -I — r- O
OWNER NAME F IIZ�( � �� moi'�// /� n J PHONE/72�/_'�� o� E-MAIL
STREET ADDRESS 0�cI (Z�(�► I i/i,/ CITY, STATE,ZIP^un,�_,,,,.,4 C,/I /a r�o/rJ FAX
CONTACT NAME PHON 2�F �X�Q/ 2 E-MAIL ����/C/, p,/��S���S�SO C�1✓�a
STREET ADDRESS? l�� ��LtiS � ,/I � CITY,STATE, ZIP l ^G� ��4r 3 FAX
OWNER ❑ OWNER-BUILDER ROWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECTS ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAACCTORNAM� � (� LICENSFrT'JMBEO •,�' LIC�JV EgEG BUS.LIC,
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COMPANYNAMEE-MAI i FAX
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STREET ADDRESS _
CITY;STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS.7 2 KILOWATTS(COAL ONL : OTAL VALUATION:
r r •� OL
DESCRIPTION OF WORK UA_ _ 6_ Q 00
q4 S_ LUPEaE' d CA
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act ona props . 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 bui construction. I whorize representatives of Cupertino to enter the above-ids Ified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY "
/�, [1 ❑ OVER THE-COUNTER
�° ❑'EXPRESS
".❑ STANDARI).
° ❑.LARGE"
❑ MAJOR
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PVApp_2011.doc revised 03/16/11