B-2016-2614 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2614
20129 SUISUN DR CUPERTINO,CA 950144427(369 28 009) SLINGSHOT POWER
INC
LOS ALTOS,CA 94022
OWNER'S NAME: MANTHIRI SOUNDARARAJAN AND SOUNDARARIAIAN RA DATE ISSUED:08/30/2016
OWNER'S PHONE:408-239-9866 PHONE NO:(650)308-9055
LICENSED CONTRACTOR'S DECLARATION ARATION BUILDING PERMIT INFO:
License Class C-10:C-46 Lic.#984488
Contractor SLINGSHOT POWER INC Date 06/30/2017 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 th t my
license is in full force and effect. JOB DESCRIPTION:
(N)14 PANEL ROOF MOUNTED PV SYSTEM(3.99 KW)
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 W¢rker's
Compensation,as provided for by Section 3700 of the Labor Code,€or the
performance of the work for which this permit is issued.
f 2. I have and will maintain Worker's Compensation Insurance,as pro ded for by
?. Section 3700 of the Labor Code,for the performance of the work fo r which this
permit is issued. Sq.Ft Floor Area: Valuation:$16000.00
APPLICANT CERTIFICATION
Icertify 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 369 28 009
representatives of this city to enter upon the above mentioned property or
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses whi h PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this pen nit. WITffiN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-poin
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
-Signature ��y� N Date 8/30/2016 Issued by:Abby A ey nde
G Date:08/30/2016
OWNER-BUILDER DECLARATION
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)
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:8/30/2016
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. I HAZARDOUS MATERIALS DISCLOSURE
2. 1 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. Health&Safety Code,Section 25532(a)should I store or handle hazardo
3. I certify that in the performance of the work for which this permit i issued,I us
shall not employ any person in any manner so as to become subject tssue 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 ce ifficate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisi ns 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. O er or authorized agent:/==L=:-- �
APPLICANT CERTIFICATION Date:8/30/2016
I certify that I have read this application and state that the above inform tion is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state I aws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and!hereby authorize representatives c f 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. e)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabi ities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant u riderstands
and will comply with all non-point source regulations per the Cupertino unicipal ARCHITECT"SDECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed _
Signature Date 8/30/2016 Professional
- ---i--.1- w-zG ,q
n,,1,P�-'w
ALTERNATIVE ENERGY PERMIT APPLICATION
COIv ! r. !
MUNI i Y DEVELOPMEN i DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CU PERTIN0',CA 95014-3255
(408)777-3228 FP-.X(408)7-77-3333•buildino(n-cuoertino.org
CUPERTINO
PROJECT ADDP=SS -1, APi R ✓�C� t G U
OWNER NAAEP'.ON'E , E-MAIL
IL
ADDRESS €l f°� r' `% 1 i C TY, ST:-.i c,Zip f/ �p F4X
lJ �J I f o
CONTACT NAMBEa ' ejyPHONE � r-n Ax
sTP,=.tT ADo;ii:Ss ( crY,STAT-w.ZIP
❑mi�,?.A ❑ OWNER-BUILDER ❑ ORZERAGEk7 ❑CON�IR.CTOR �COhMA4CTORAGZN ❑ ARmu1 .= ❑E-NG='-R ❑ DEVELOPER ❑T'_NAhTr
CONTRAC ivio 6� U5uj LI ENS'r I LT BER(, /� � Lr—'(Q a g I BU LI n.
1 [ -1 ts� l" L f
COMIPANY14ME `, i (� I nod L I FAX
STF i ADDRESS � �/ CITY,STATE,ZIP (tns
PHONE
ARCMC',iZINGINEER NP.h4E I LI�ZNSE I\TWBER BUS.LIC-,'
COMPANY NAME I E-M IL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
i
Un_OF -,/SFD or Duplex ❑ l\Illlfl-t2111YIy PiOJECT IN WILDLAND PROJECT IN
STRUCTURE: F-1Commercial I 1-T
-2Bah RNr,RFACE AREA [I Yes ❑ NO FLOOD ZONE E3 Yes El No
a--50—LIR PANELS I 13 ELECTRIC VEMCLECuARGINGSTAIITTON ( El SOLAR WJATERYc4TING El OT R:
FOR SOUR FAEELS: h'UI,!BER OF PAiv%LSltLNITS: KILOWATS(CO'`41,�ERCIAL ONLY): R TOTAL VF r UATION: / /r�/'g
ESCRIPTIOA'OF WORx \ Ck\\ 6\ SM . q�� W\ � (�(
IDo�
By my signature below,I certiii=to each of the foil owing: I-m the.froperty or Puthor ized agent to act on the property ozmM:r's behalf. I h_Ne read this
application and the information I have provided is correct. I ha-v.-read the Description o:Work and verify it is accurat I agree to comply With a]I applicable local
or.di gees and state la«s, latin-to building cons ruction. I Lthoriz�representatives of Cupa-iuno to enter the above-Ze/Pntif/Ted prope,y for inspection purposes.
S i natu,e cr npplicant/4g..nt. - Date: 9IL11 16
SUPPLEMENTAL i vtOlZ>\!ATIQ yr REQUIRED
n
Q -
PRESS
�__a �Z4RGE -
0 2Zd70R__
Pt%4Rp 201 J2,oc revised 03/16/11