B-2017-0004CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017,3392
22106 LINDA VISTA PL CUPERTINO, CA 9501411022 (356 08 009) HOMENET WORKS,
ELECTRIC & SOLAR,
SAN JOSE, CA 95127
OWNER'S NAME: RAJARAM GOKUL TRUSTEE & ET AL I I DATE ISSUED: 01/03/2017 I
OWNER'S PHONE: 650-492-3525 I I PHONE NO: (408) 254-4663 I
License Class C-10 Lic. #820184
Contractor HOME NETWQRKS ELECTRIC & SOLAR Date 05/31/2017
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.
hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self -insure for Worker's
BUILDING PERMIT INFO:
BLDG _ ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(I) 26 -PANEL ROOF MOUNTED PV SYSTEM (8.5 KW)
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 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. Sq. Ft Floor Area: valuation: $10000.00
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
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 regulatiper the Cupertino Municipal Code, Section 9.18.
Signature % Date 01/03/2017
hereby affirm that I am exempt from the Contractor's License Law for one of the
"N Number: Occupancy Type:
356 08 009
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abby Avende
two reasons: All roofs shall be inspected prior to any rooting material being installed. It a root is
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)
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: 01/03/2017
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
1 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 01/03/2017
11 A 11
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, Se ti s 25505, 25533, and 25534.
Owner or authorized agent: _
Date: 01/03/2017
CONS TRCTION LE ING 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
ALTERNATIVE ENERGY PERMIT APPLICATION
112 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building
cupertino.org8
---,1 r=l- -
PROJECTADDREss 22106 Linda Vista Place
APN# 447-27-110
OWNERNAME Ra aram, Gokul & Tamaram
PHONE 650-492-3525 7
MAR, tamarar@gmail.com
@gmail.com
STREET ADDRESS 22106 Linda Vista Place
P CITY, STATE, ZIP Cupertino, CA 95014
FAX
CONTACT NAME Katrina Garcia
PHONE 408-254-4663 ext 101
E-mAu- kgarcia@homenes.com
STREET ADDRESS
838 Charcot Ave.
CITY, STATE, ZIP
San Jose, CA 95131
FAX
408-254-4699
❑ OWNER ❑ OWNER-BUB,DER ❑ OWNER AGENT ❑ CONTRACTOR XCONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Randy D. Garcia, Sr.
LICENSE NUMBER 820184
LICENSE TYPE
C-10, C-46
BUS. LIC #
COMPANY NAME Home Networks, Electric & Solar
E-MAIL kgarcia@homenes.com
FAX 408-254-4699
STREET ADDRESS
838 Charcot Ave.
CITY, STATE, ZIP
San Jose, CA 95131
PHONE
408-254-4663 ext 102
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF X SFD Or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes X NO
PROJECT IN
FLOOD ZONE ❑ Yes X NO
X SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OFPANELS/UNTPS: 26 YJLOWATTS (COMMERCIAL ONLY):
TOTAL VALUATI : $10000
DESCRIPTION OF WORK
Install roof -mounted photovoltaics stem. System size 8.502kW
RE D Y:
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 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 buil . goo struction. I authorize representatives of Cupertino to enter the above -identified/ propertyfor inspection purposes.
Signature of Applicant/Agent: / Date: "L 7
SUPPI EMElrITTAL INFORMATION REQUIRED
�..
a
OFFICE, USE ONLY
W
OVER-THE-COUNTER
a+
❑ EXPRESS. .
?
❑ STANDARD
a❑
LARGE
❑ MAJOR
PV4pp_2011.doc revised 03116111