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B-2016-3237CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3237 20790 GREENLEAF DR CUPERTINO, CA 95014-1819 (326 30 175) HIGHLIGHT SOLAR INC A CALIFORNIA CORPORATION SAN JOSE, CA 95117 OWNER'S NAME: SAMANTAARINDAM AND SANJUKTA DATE ISSUED: 12/08/2016 OWNER'S PHONE: 310-936-1866 1 1 PHONE NO: (408) 489-9273 License Class Q=4& Lic. #980376 Contractor HIGHLIGHT SOLAR INC A CALIFORNIA CORPORATION Date 04/30/2019 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. 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. 6_1. I have and will maintain Worker's Compensation Insurance, as provided for by BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 23 -PANEL ROOF MOUNTED PV SYSTEM (7.70 KW) REV#1 - RE -ARRANGED PANELS - ISSUED 5-31-2017 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $34820.00 permit is issued. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, theapplicant understands and will comply with all non -point source regulationper the Cupertino Municipal Code, Section 9.18. Date sbiP4si�l Ma t : I_ l �DECL#R4TM I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 05-31-2017 APN Number: Occupancy Type: 326 30 175 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. . a _ �, _ Issued by: Abby Aygnde Date: 12/08/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant:, Date: 05-31-2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ctions 25505, 25533, and 25534. Owner or authorized agent: Date: 05-31-2017 CONSTRUCTIO LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO ALTERNATIVE ENERGY PERMIT [j APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDITJGr0AISON # 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building (@cupertino.org 5' 2o i b - 32 3 �-- PROJECT ADDRESS o r APN # OWNERNAME 4 ,� 4 f'� 3 g s E-MAIL STREET ADDRESS �V ^� Q CITY, STATE, ZIP9-,3I FAX CONTACT NAME PHON I. O L� Q Z'] 2 %1,• M GIV STREET ADDRESS S 4 PC. r v 12 !% V `- CITY, STATE, ZIP q S-)/) FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 2u LICENSE NUMBER (�� n � � ` u LICENSE TYPE C.' � � BUS. LIC # COMPANY NAME j�) . / ` �E-MAIL �T � ( 1` FAX STREET ADDRESS 355 p �. vQ CITY, STA , ZIP w. o PHONE ARCIIITEC TNGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS��� CITY, STATE, ZIP PHONE qqq USE OF SFD or Duplex ❑ Multi-Fatnily STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION i ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF P.ANFLS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRTPTIUN OF WORK w; 1 ,.. DF 1 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p operty owner's behalf. I have read this application and the information I have prov ed 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 build construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: D �� SUPPLEMENTAL INFORMATION A'G d n -A OFFICE USE ONLY ❑ OVER-THE-COUNTER a F' ❑ EXPRESS v v ❑ STANDARD ❑ LARGE ❑ MAJOR PVApp_201 Ldoe revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3237 20790 GREENLEAF DR CUPERTINO, CA 95014-1819 (326 30 175) HIGHLIGHT SOLAR INCA CALIFORNIA CORPORATION SAN JOSE, CA 95117 I OWNER'S NAME: SAMANTAARINDAM AND SANJUKTA I (DATE ISSUED: 12/08/2016 OWNER'S PHONE: 310-936-1866 PHONE NO: (408) 489-9273 License Class C-46 Lic. #960376 Contractor HIGHLIGHT SOLAR INCA CALIFORNIA CORPORATION Date 04/30/2017 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. 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 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB _ MECH X RESEDENTIAL _ COMMERCLAL JOB DESCRIPTION: (I) 23 -PANEL ROOF MOUNTED PV SYSTEM (7.70 KW) Compensation, as provided for by Section 3700 of the Labor Code, for the performance 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 Sq. Ft Floor Area: Valuation: $34820.00 permit is issued. APPLICANT CERTEFICATION I certify that I have read this applicationand state that the above information is 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 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations pe/the Cupertino Municipal Code, Section 9.18. Date 12/812016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Coae, for the performance of the work for which this permit is issued. 2. 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 12/8/2016 APN Number: Occupancy Type: 326 30175 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby A3 and RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 12/8/2016 BE CLASS "A" HAZARDOUSMATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti ns 25505, 25533, and 25534. Owner or authorized agent: Date: 12/8/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINC? �-Wt(o- 2Z ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingC(Dcupertino;org PROJECT ADDRESS o ! f V C e ��.G ` APN OWNER NAME U PHONE E-MAIL STREET ADDRESS i CITY, STATE, ZIP FAX o cit L �. / CONTACT e�� NAME / �y Q q v� �►//� ` 1 / � C� PHOq � .,,°G ,D 6 l � 7' }y /c�C6a ,U • "� k� � C STREET ADDRESS ` CIT CLATE, ® _ l S t F � J� I E] OWNER ElOWNER-BUILDER13OWNERAGENT 1.�CONTRACTOR ❑ CONTRACTORAGE'N'TT ❑ ARCHITECT ❑ ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR N t LICENSE NUMBER; - LICENSE TYPE BUS. LIC # COMPANY NAME ; i`+•1 E-MAIL FAX LJ / A t STREET ADDRESS E, CITY, STATP PHO �0 �9z�3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ulti-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No. FLOOD ZONE ❑ Yes ❑ NO u SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: , KILOWATTS (COMMERCIAL ONLY): /��` TOTAL VALUATION: e i , x ` Q 0 DESCRIPTION OF WORK % J (� Z} n Lir- RECEIVED BY 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 hate read this application and the infonnation I have p vided 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 bu lm" a,construction. I authorize representatives of Cupertino to enter the above -id tifie�d}pro rty/foorr inspection purposes. 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