B-2017-1294CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1294
10561 CASTINE AVE CUPERTINO, CA 95014-1310 (326 44 034) BAY AREA SOLAR
SOLUTIONS INC
PLEASANTON,CA
94588
OWNER'S NAME: EKAMBARAM PORKODI AND SATRAWADA RAVI
OWNER'S PHONE: 408-480-8284
LICENSED CONTRACTOR'S DECLARATION
License Class C10 Lic. #928652
Contractor. BAY AREA SOLAR SOLUTIONS INC Date 02/28/2019
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.
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
nermit is issued.
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 applicantunderstands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
I hereby affirm that I,ani 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'owi6r 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.
z. 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
I certify that I have read this application and state that the above information is
correct. I agree to'comply with aff 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 08/07/2017
ISSUED: 08/07/2017
PHONE NO: (925) 380-9500
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCLAL
JOB DESCRIPTION:
(I) 14 -PANEL ROOF MOUNTED PV SYSTEM (4.270 KW)
Sq. Ft Floor Area:
Valuation: $14000.00
APN Number: Occupancy Type:
326 44 034
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 08/07/2017
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 ofAppli
Date: 08/07/2017
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, Sections 255 , 25533 a 5534.
Owner or authorized agen �/ L
Date: 08/07!2017 CONSTi
TI L Y
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 APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE
(408) 777-3228 • FAX (408) 777-3333 + buildin-galcupertino.org
R -In A -:I- I %_QI L/
PROJECT ADDRESS
7AP
'
10561 Castine Avenue
326-440-34.O
OWNERNAME
PHONE
E-MAIL
Ravi 'Satrawada
408-480-8284
Rsatrawada@gmail.com.
STREET ADDRESS
CITY, STATE, ZIP
FAX
10561 Castine Avenue
Cupertino,Ca; 95014
CONTACT NAME
PHONE
E-MAIL
John Woolway
925-380-9500
John.Woolway@yourenergysolutions.com
' STREET ADDRESS
CITY, STATE, ZIP
FAX
6700 Santa Rita Rd Suite E
Pleasanton, CA, 94588
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER -AGENT ❑ CONTRACTOR [a CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER , ❑ DEVELOPER ❑:TENANT
CONTRACTORNAME
Lou Zughbaba,
LICENSE NUMBER
928652
LICENSE TYPE
C10;
BUS. LIC #
COMPANY NAME
E-MAIL "
FAX
Your Energy Solutions
Lou.Zughbaba@yourenergysolutions.com
'
STREET ADDRESS ii ';
CITY, STATE, ZIP
'PHONE
6700 Santa Rita' R D Suite E
Pleasanton, CA;94588 , ;
.I 9253809500 '
ARCHTTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
i
,FAX. '
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD OrDupleX Multi -Family
PROJECT IN WILDLAND
PROJECT IN;
El COmmelClal
URBAN INTERFACE AREA ❑ Yes I] No
FLOOD ZONE El Yes EI No,
STRUCTURE:
D SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
D SOLAR WATER HEATING
I-. OTHER:
FOR SOLAR PANELS: NUMBER,OF PANELstgmrS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
14 4.27,
$14;000
DESCRIPTION OF WORK �.
Ih'stillation of:141f ahels (system Size 4.270)
YED P i
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 Ibyw' g cons n. I authe 'ze a bes u ertino to enter the above -identified property for inspection; purposes.
Signature of Applicant/Agent: Date: 8/4/17
SUPPLEMENTAL INFORMATION REQUIRE
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P.VApp_201'l:doc revised 03116111