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B-2017-1305CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1305 21491 COLUMBUS AVE CUPERTINO, CA 95014-4972 (362 04 012) HOUSING CONSTRUCTION INCORPORATION WALNUT CREEK, CA 94596 OWNER'S NAME: PRATIVADI SRIDHAR AND KALPANA TRUSTEE OWNER'S PHONE: 408-891-6503 LICENSED CONTRACTOR'S DECLARATION License Class B Lie. #890090 Contractor HOUSING CONSTRUCTION INCORPORATION Date 01/31/2019 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: r. 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 ection 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 regulatiops per the Cupertino Mlmicipal Code, Section 9.18. Sig tr P 1:44 Date 08/08/2017 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) z. I, as ownenof 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: r. 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 complywith 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. a- - ssLZKGIIA DATE ISSUED: 08/08/2017 PHONE NO: (415) 910-6808 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 30 -PANEL ROOF MOUNTED PV SYSTEM (9.9 KW) Sq. Ft Floor Area: I Valuation: $33579.00 APN Number: Occupancy Type: 362 04 012 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 08/08/2017 R&ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 08/08/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, ections 25505, 25533, d 25534. Owner or authorized agen Date: 08/08/2017 CTI I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO PROJECT ADDRESSV APN 0 RNAME P 1 --MAIL /� �. PA -n ! ` O" _ S A - 1� ST'E[ DRESS Co CITY STATE, ZIP Q FAX (ft CONTA1CT AME PHO E E-MAII , 1S . _ Mil STREET ADDRESS CITY, STATE, ZIP u FA ; ❑ OWNER ❑ OWNER -BUILDER . '❑ OWNERAGENT )<CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C ATRA�T ORNAM LICE E NUMBER LI TYPE BUS. v 3 Z ►� v a COMPANY NAME E-MAIL aj!Alln @— Jo FAX — 2 -go --2syse ST$E fDRESS v , ^ _^ CITY, ST TE, ZI e PH Mr- _ ARCHITECT,ENGINEER NAME i LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE:OF k SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROTECT IN ❑ !CGmmerClal URBAN INTERFACE AREA ❑ Yes � NO FLOOD ZONE ElYes 1:1 NO STRUCTURE: SOLAR. PA�'ELS ❑' ELECTRIC VEHICLE CHARGING STATION FO SOLAR WATER HEATING ❑ OTHER: FOR'SOLAR PANELS:: NtiMBER OF PANFLS/[JNITS: KILOWATTS (COMMERCIAL ONLY): T T V UATION: p J DESCRTPTIUN QF \k'ORlC f i. KI.J C OL,fc- Jk..- ti RECE D B 1 f i By my sianatare below, I certify to each of the following: I am the property owner or authorized agent to act on V e pro erty ov ner's,behalf. I have read this application and tt e; infonvation I, have provj d is correct, I have reao the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state' laws relating to building c nshuction. I autho ' representatives of Cupertino to enter the above-identifi d prope for inspection purposes. Signature of Applicant/Aoent: i �+ Date: SUPPLEMNT L INFORMATION REQUIRED Y � � ❑ 01rER THE COUNTER � S ❑EXPRESS£ 4� z �s ❑ j LARGE � � a ,� ^: es v: � � �, �`� ��❑Z�7AJQR PVApp_2011.docrevised 03/16/11 CUPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org .PERMIT CANNOT BE FINALED V.NTI ,THIS CERTIFICATE.HAS BEEN comp LETED "h -:AND RT'TUR�r�;n T0 fiiflE BUILll1NG Di�iSit"�N m PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 CBC Sections 420 6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) On every level of a dwelling unit including basements Within each sleeping room SMOKE ALARM X CO ALARM X X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below Address- % CJ V V.LJY Permit No. 0-'LOC7 -1-jo5 Specify Number of Alarms: # Smoke # Carbon Mc I have read and wiree fn rmmnly 1Afifh fhc fcr nn 4 nn. 4,*f;...,... r fL.;.. -4-4 Owner (or Owner Agent's) Name: S �b4>> Signature `.�. Date: Contractor Name: Signature Lic.# Date: Smoke and CO fonmdoc revised 12115/16