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B-2016-3144 { I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3144 18640 CRABTREE AVE CUPERTINO,CA 95014-3809(375 26 057) FUTURE ENERGY CORPORATION I WILTON,CA 95693 SI OWNER'S NAME: SHAH BHARAT R AND BHAVNA B TRUSTEE DATE ISSUED:';11/28/2016 OWNER'S PHONE:408-203-4455 PHONE Nth(800)985-0733 I LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GLAZING Lic.#463720 l Contractor FUTURE ENERGY CORPORATION.Date 10/31/2018 X BLDG _ELECT _PLUMB —MECH X RESIDENTIAL__COMMERCIAL I hereby affirm that I am 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: penalty perjury (N)31-PANEL ROOF MOUNTED PV SYSTEM(6.00 KW) I herebyaffirm under enal of erju one of the followingtwo declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's as provided for by Section 3700 of the Labor Code,for the oimance of the work for which this permit is issued. çmsalion, 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 1 permit is issued. Sq.Ft Floor Area: Valuation:$42450.00 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 375 26 057 , 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 compl ith all non-point � p source regulations per the Cupertino Municipal Cod , ection 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatures : Date 11/28/2016 Issued by:Kim Dunbar Date: 11/28/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the roofs shall be inspectedprior to anyroofing material being installed.If a roof is RE-ROOFS: 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(Sec.7044,Business&Professions Code). Date:11/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. I have and will maintain a Certificate of Consent to self-insure for Worker's it 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. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 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 ,•:ter 9.12 and exemption,I become to the Worker's Compensationprovisions of the s 25505,2553 ,.r' `'. Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent. . - P subjectP the Health&Safe Code,Secti PY be deemed revoked. L a„ /..- APPLICANT CERTIFICATION Date:11/28/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state 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. I understand my plans shall be used as public records. SiSignature • Date 11/28/2016 Licensed g Professional a , 13-1(2)1,(e \ - ("cc/ ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 't, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingia cupertino.orq PROJECT ADDRESS 61y0 �? APN# u- OWNER NAME I.nL G it •�lp� PHO 0) 03 __eel E-MAIL � STREET ADDRESS (. p y�' etb a p FAX CITY,STATE,ZIP ( `� li(� CONTACT NAME S. n PHO E-MAIL STREET ADDRESS CITY,STa E,ZIP .. y FAX I t ldJ Y� L '(t SCS-I 3 ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT ONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER• 0 DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE ER 2LICENSE'E Q BUS.LIC# 3t COMPANY NAME h yp E-MAIL FAX 1 ince. 'e i Y - - STREET ADDRESS it) I eirC Le CITY,STATE;ZIP v. -4 { Y! 11-41:242) 514-' lit ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP !PHONE USE OF ❑ SFD or Duplex El Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: LI Commercial URBAN INTERFACE AREA CIYes LINo FLOOD ZONE LIYes 0 No LAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS UNITS: KILOWATTS(COMMERCIAL ONLY): ;1< TOTAL VALUATION: Li s DESCRIPTION OF WORKSi A-- 7 'Il® ct\ ) «31, r4 is RECEIVED BY: By my signature below,I certify to each of the fo a•me I am •e property owner or authorized agent to act on the property owner's beh If. I ha ve read this application and the information I have provita is correct. I h._ -read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances'and.state laws relating to b " i i ction. I.ui okize representatives of Cupertino to enter the above-identified property for inspection purposes. • Signature of Applicant/Agent: //-f Date: -(', SUPPLEMENTAL INFO ATI N REQUIRED ,OFFICE USE-ONLY r LiOVER THE COUNTER Q 1A1 Y�� ©'EXPRESS-. iia/Z"" STANDARD fl MAJOR'," PVApp_2011.doc revised 03/16/11