B-2017-0430CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0430
1272 POPPY WAY CUPERTINO, CA 95014-5305 (366 19 043) ALL BAY SOLAR
SAN FRANCISCO, CA
94112
OWNER'S NAME: GUDDANTI SESHU KAND KADAVERU SHALINI
OWNER'S PHONE: 408-220-4140
LICENSED CONTRACTOR'S DECL R TIl
License Class C-10: C-46 Lic. #962034
Contractor ALL BAY SOLAR Date 06/30/2017
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
,performance of the work for which this permit is issued.
c��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.
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.
Date 3/15/2017
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.
s. 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
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 3/15/2017
ISSUED: 03/15/2017
NO: (415) 655-3090
BUILDING PERMIT INFO:
BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
UPGRADE PANEL (225 AMP) - SAME LOCATION
Sq. Ft Floor Area; Valuation: $1000.00
"N Number: Occupancy Type:
366 19 043
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: AbbA, eS nde
Date: 03/15/2017
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: 3/15/2017
ALL ROOF COVERINGS TO BE CLASS "A"
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, Sections 25505, 25533, and 25534.
Owner or authorized agent: Gr
Date: 3/1 512 01 7
CONSTRUCTION LENDING AGENCY
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
s 1
MRVEMX�WSIL
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@-cupertino.org
1 IPLUMBING F-IWCI4 A MT( -A I. 117CUrlTO AT 1 I
"- LL .,+..i;�.
PROJECT ADDRESS $,
ii�+�.ni. LJ1V11J1.1=,LLHiVLV UJ
APN #
OWNERNAME
PHONE (Xa_Z_?(j q
E-MAIL
STREET ADDRESS J�
CITY, STATE, ZIP ) p
FAX
CONTACT NAME I
y
J 2
PHONE �P624
J���DS��
E-MAIL b �' �� yam' EUV -
`.
STREET ADDRESS &
km%5� %o 171-
1 CITY, STATE, ZIP 5, cp�li
FAX
❑ OWNER ❑ OwNER-BuiLDER. ❑ OwNERAGENT . I!'1 CONTRACTOR ❑ CONTRACTOR AGENT , ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME n
(moi
LICENSE NUMBER
cl 6
LICENSE E
TYP
c f o- C46
BUS. LIC i#
�11�
COMPANYNAMEE-
jj {�^I
6� r�1�1 U Y
E-MAILG
_-
�t�El�rA 76t� (
FAX
STREET ADDRESS
vvV+��1�J� 'S
CITY, STATE, ZIP > _ y� �
�i 11i (Lt1T GisC CJI��GI
p
PHONE f 2qy3 S �
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 71FD.7 DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WHALAND ❑ YES
URBAN INTERFACE AREA ® NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
Is TFC. BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK +� r
c qpb 22%�
T
TOTAL VALUATION: , ��
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 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 build g c ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
r'
Signature of Applicant/Agent: f Date: �f S r/ 1 —2—
S PLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
-
❑ EXPRESS -
u
❑ STANDARD
i?
0 LARGE
a.
❑ MAJOR
MEPMiscApp 2011. doe revised 06121111
1�
1. Is your real property a registered historical rfite?
11 Yes Civil Code Sections 1101.1 through 1101.8 donat-z#rAv- Skin the -r-stof the
2. Doei your real property have a licensed plumber cerffying J. due to th.e age or configuration of the property or its
plumbing, installation of water -conserving plumbing atures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
D TLe licensed plumber's certification has been provided to the Building Division.
Sk�p the rest of the form and sign bottom of form.
11 No Go to Question 3.
3. Is water service permanently disconnected &r your building?
11 Yes Civil Code Sections 1101.1 throul 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form.
19
0 No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through i ins do not ap4ly. skip therestof the formand sign bottom of fom
0 Yes My real property is built and available for use or occ-UpMcy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form.,
1, es the owner or owner's agent of this propmV, certify under penalty of peijury that non-compliant plumbing fixtures wifl be
replaced prior to date specified above with water -conserving plumbing fixtms iu. accordance with Civil Code Sections 1101, 1
through 1101.8, the currentCaliforrAa Plumbing Code and California Green Building Standards Code, and manufachuWs
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on ft followink vaee.
Owner or Owner Agent's Signature.:
SB4072015.doc revised 08126115 �