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B-2016-3249
CITY OF CUPERTINO BUILDING PERM T BUILDING ADDRESS: CONTRACTOR: PE' T NO:B-2016-3249 10781 JOHNSON AVE CUPERTINO,CA 95014-3819(375 31 060) FIDELITY HOME ENERGY INC SAN LEANDRO,CA 94577 OWNER'S NAME: RAYAPATI VENKATAPATHI N AND VUAYASRI D.TE ISSUED:12/09/2016 OWNER'S PHONE:408-970-8616 PH'NE NO:(510)957-2220 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT I 0: License Class B:C-17:C-33 Lic.#790709 Contractor FIDELITY HOME ENERGY INC Date 01/31/2017 X BLDG _ELECT _P UMB MECH X RESIDENT 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: (N)20 PANEL ROOF MO TED PV SYSTEM(6.0 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 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 ill°Section 3700 of the Labor Code,for the performance of the work for which this de permit is issued. Sq.Ft Floor Area: Va nation:$20000.00 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: Oc upancy Type: and state laws relating to building construction,and hereby authorize 375 31 060 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 EXP ' S IF WORK IS NOT STARTED may accrue against said ity in consequence of the granting of this permit. WITBIN 180 DA S OF PERMIT ISSUANCE OR Additionally,the appl's<n understands a •will comply with all non-point source regulation •e e Cupe� (_'•al Code,Section 9.18. 180 DAYS FRO LAST CALLED INSPECTION. "Signature gr... "-S- s-te 12/9/2016, Issued by:Abby Ayende Date: 12/09/2016 OWNER-BUILDER DECL• ' •TION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: -- following two reasons: - All roofs shall be inspected p'or 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 obta..'i: 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:12/9/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF CO aRINGS TO BE CLASS"A"OR BETTER i, 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. HAZARD 10 US 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&Safe Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with t',e Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Se tion 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,sho Id I use equipment.evices which emit hazardous air contaminants as defined by the Ba _ ea•.1 e.ality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance w'h the pe,'%.P�' cipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe •,de,S,, i ons ,81 • .d 2 4. Labor Code,I must forthwith comply with such provisions or this permit shall -, be deemed revoked. C Owner or authorized age t: APPLICANT CERTIFICATION Date:12/9/2016 I certify that I have read this application and state that the above information is s ' t CTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that ther= s - construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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 AR is t TECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 12/9/2016 Professional ?)---20go,Z24 ALTERNATIVE ENERGY PERMIT APPLIC . TION (-44 9,,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISI•NA E �,.t�� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTI�� (408)777-3228• FAX(408)777-3333•buildinq(a�cupertino.orq PROJECT ADDRESS (07,/ p / 4 cJ 14 t ' 4 'J�j APN# �3 s /1 OWNER NAME PHONE E-MAIL STREET ADDRESS S ATE ZIP FAX �fl7�� U�hhs�A ..e - CITY, �Ui4rt7 C4 . CONTACT NAME -ie 9 ( PHONE _970—. gi/1 E-MAIL STREET ADDRESS /©7 6/ L Son bi� CITc STATE,ZIP.,6 K1 FAX ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENTT1'F CONTRACTOR 0�fCOO_rNTRAACTOR AGENT 0 ARCHTTE T 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME_ ...AP.,. / ay � ,- LICENSE NUMBER"'�-®gyp j`,(a LICENS., ' •E BUS.LIC#zq.60I COMPANY NAME reir E-MAIL FAX G1'7i9 ham cn, /�/ STREET ADDRESS , ,61 aorD ✓ CITYATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 0 SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: 0 CommercialURBAN INTERFACE AREA 0 Yes 0 Nu FLOOD ZONE 0 Yes 0 No Ab 'SOLAR SOLAR PANELS 0 ELECTRIC VEHICLE C GING STATION 0 SOLAR WATER HEATING 0 OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: ��, (Q KILOWA;€�FS�CQ RCIAL ONLY): TOT ?�LU6TIOT, DESCRIPTION OF WORK (/-t l/�` 4-1/ CJ V JRECE D BY By my signature below,I certify to each of th- o:.wing: 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 qv.e''s correct. I have read the Description of Work and verify it is accurat-. I agree to comply with all applicable local ordinances and state laws relating to .ui. •l .nstructio. I..yo": ---presentatives of Cupertino to enter the above id- tifiejropertyffor specfion purposes. Signature of Applicant/Agent: Date: "� / �w,-e-- jam'L NTAL INFORMATION REQUIRED •FFiCE USE ONLY 1 �' 0 OVER-THE-COUNTER H 0 EXPRESS ❑- STANDARD U 0:LARGE / I:. , - -- -_0 MAJOR • PVApp_2011.doc revised 03/16/11