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B-2016-2810 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT :B-2016-2810 1172 SCOTLAND DR CUPERTINO,CA 95014-5026(362 28 004) SUNRUN INSTALLATION SERVICES INC SAN LUIS OBISPO,CA 93401 OWNER'S NAME: PRATHURI CHANDRA AND SREEDHARA RAMA D DATE ISS D:09/27/2016 OWNER'S PHONE:408-320-4258 PHONE NO:(415)580-6900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class S46 Lic.#750184 Contractor SUNRUN INSTALLATION SERVICES INC Date 06/30/2018 X BLDG —ELECT —PLUMB MECH X RESIDENTIAL_C DMMERCIAL I hereby affirm that Lam 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.` JOB DESCRIPTION: (1)17 PANEL(3 ARRAYS)ROO MOUNTED PV SYSTEM(4.5kW) 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. f I have and will maintain Worker's Compensation Insurance,as provided for by Section 3760 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation: 11495.00 APPi.ICANT 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 362 28 004 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 er the o Municipal Code,Section 9.18. 180 DAYS FROM LAST C,,AL��' D INSPECTION.. Signature Date 09/27/2016 Issued by:MELISSANILUIe' Date:09/27/2016 I hereby affirm that I empt from the Contractor's License Law for one of the following two reasons: ,All roofs shall be inspected prior to air y 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 insr ection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for it pection. sale(Sec.7044,Business&Professions Code) z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 Code,for the performance of the work for which this permit is issued. HAZARDOUS M TERIALS 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 permit is issued. maintain compliance with the Cup e o Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25 32(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 Qu . CManagement District I Worker's Compensation laws of California. If,after making this certificate of will.maintain compliance with the Cupertino M p ode,Chapter 9.12 and exemption,;I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se Vons 2 5, 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be.deemed revoked. owner or authorized agent%' APPii ICANT CERTIFICATION Date:09/27/2016 I certify that I have read this application and state that the above information is l hereby affirm that there is a const ucf n le ding agency for the performance 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 of work's for which this permit is is u (S 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, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITEC , S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 09/27/2016 ALTERNATIVE ENERGY PERMIT APPLICATION i COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 GUPERTfN0 (408)777-3228• FAX(408)777-3333 building aacupertino.org PROJECT ADDRESS y fAPN# OWNER NAME �' l/-> ✓7 �`Jl/ �00 �Fj �( ! PHO E-MAIL STREET AD��' CITY, ATE Y/ W FAX CONTACT NAME PHONE�d `�'��✓ /� E-MAIL�"I �G�+�.J°�'U� J((//Jf��✓r/v�dylG✓� .�4f2 �DG REZ-sFR�s�`� A � C Y,STAT��P / ❑ OWNER ❑ OWNER-BUILDER : ❑ OWNER AGENT 'TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER_ ❑ TENANT S CONTRACTOR NAI IE LIC E LICEN E TYP�E�` BUS.LIC 9 N N COMPANY NAME �,j }yf;: /� E-MAIL REST ADDRESS y/ I CITY, TATE,ZIP, ARCHITECMENGINEER NAME LICENSE NUMBER (/ V/ J l / ]BUS.LICGL/T) COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF d SFD or Duplex ❑ Multi-Family PROJECT IN WILpiAND PROJECT IN STRUCTURE'. ❑ Commercial URBAN INTERFACE AREA O Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO /SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING EI'OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UN1TS: t KILOWATTS(COMMERCIAL ONLY): y TOTAL VALUATIONRAM / /} DESCRIPTION OF WORK °L ....--^'•.....-.-...--..., �R�E,CEIVED BY 3 ,�t�._+moi��r ��- y�..1�'�` ;.-'"cam K� By my signature below,I certify to each of the following: I am the property own -at<thorized agent to act on the propee alf. I have read this application and the information I haveyprovide c rrect. I have read the Description of Work and verify it is applicable local ordinances and state laws relating bi'Iildi oust ction. I au orize representatives of Cupertino to enter the above-identi ted pr petty for inspection purposes. Signature of Applicant/Agent; f( Date: �� (11115 SUPPL -NTALINFORMATIONREQUIRED }i o c> asEonzYk' S ��'''''`` s � IR THF�CO�IL�IxERe`"r. 'cr.}, 4`� .c .S'3'..1 l "�---� ��" "v f•> ��'�. � >'°��STAi'DARD�'��,,.., �`''�a.�- S G, Y 4C+ I LARGE PM,4pp_2011.doc revised 03/16/11