B-2017-1478 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1478
10455 BYRNE AVE CUPERTINO,CA 95014-2813(357 12 066) COMPLETE SOLAR
SOLUTION OF
CALIFORNIA INC
SAN MATEO,CA 94404
OWNER'S NAME: PATCHIPALA SESHARAO AND PADMAVATHI TRUSTEE DATE ISSUED:09/05/2017
OWNER'S PHONE:408-205-9500 - PHONE NO:(855)541-6703
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#961988
Contractor COMPLETE SOLAR SOLUTION OF CALIFORNIA INC Date X BLDG'_ELECT _PLUMB
06/30/2019 • _MECH X RESIDENTIAL_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 JOB DESCRIPTION:
license is in full force and effect. (N) 14-PANEL ROOF MOUNTED PV SYSTEM(4.06 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
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
��,�
.erformance of the work for which this permit is issued.
V, 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 Sq.Ft Floor Area: Valuation:$20300.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 357 12 066
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source ulations per the Cupertino Municipal Code,Section 9.18.
•
Issued by:Jasmine Archbold
ignature 'ate 9/5/2017 Date:09/05/2017 •
OWNER-BUILDER DECL• '.' RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection;I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:9/5/2017
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and wilt maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health•&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,'Section 25532(a)should I store or handle hazardous
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,1 material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of Califomia. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
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 Ownuthori
A- zed agent:
be deemed revoked. D,t,Ijy �1
APPLICANT CERTIFICATIONCONSTRUCTI! Y
LENDR - • NC
i'
certify that I have read this application and state that the above information is I` ereby affirm that there is a cN- - • ending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
• to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed •
Professional
Signature . Date 9/5/2017
\ / ALTERNATIVE ENERGY PERMIT APPLICATION AE .
/' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
„s-c.)..,,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERI-IN4 (408)777-3228•FAX(408)777-3333•buildinqacupertino.orq
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PROJECT ADDRESS ) O [A y .. ,20 1—,3 Aix._ APN# ` 1 Z @ co
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STREET A[)DRESS 1 CITY,STATE,ZIP FAX
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CONTACT NAME E-MAIL .
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STREET
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FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR ACONTRACTORAGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
Cco.A^ RLNEIAME6__ 3 C71. 504)7 I ao,j LICENSE NUMBER r(J Q/ / G744 LICENSE TYPE�/� BUSS.FICO c ot_73
COMPANY NAME E-MAIL / FAX
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STREET ADDRESS CITY,STA ZIP P ONE
1Q 5 o G A-1/UJAY 72 , 5-re L So `-,A-J' W1Aco1 c_A 9`f `�0`( so• 204 'x/336
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
1
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IX SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE 0 Commercial URBAN INTERFACE AREA 0 Yes 0 No FLOOD zoNE 0 Yes 0 No
SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: l 14 KILOWATTS(COMMERCIAL ONLY): 24-0 6 TOTAL VALUATION:c 2 cc1ieict
-1 I Jll�
DESCRIPTION OF WORK
I�,-1,x.11 14-4371C- M 0-0/J 1 pfrfe,10 Jo r M c .
AP::, 'T' j ( IJ / t A'1)6 •
RE BY: • 11/1501
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pprrope owner's behalf. I hhaave read this
application and the information I have provided is correct. I have read the Description of Work. . --• . 's accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize re.c -.Y - - . upertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: II 5W)) )
CEMENT• - i 1 ORMAT Z!, '_0 9UIRED OFFICE USE ONLY
❑ OYER-THE-COUNTER
❑ EXPRESS
W
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. ❑ STANDARD
V -
LARGE
0 MAJOR
PVApp_2011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
sg COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinqcupertino.orq
T CANNOT BE FINALED UNTIL TOW CERTIFICATE IHAS:BEEN
CO PLETED,.SI-CNED RETURJ ED.T.O BUILDING DIVISION.
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 SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room 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- 10 55 B '/RNE r 'JG- (LOPERT1 N.)O; Clot Permit No 13-2011—147,g
Specify Number of Alarms: #Smoke Alarms. g I #Carbon Monoxide Detectors 12
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name.
Signature ./ + Dater j-) 9--
Contractor Name: -
Signature Lic.# Date:
Smoke and COfonn.doc revised 12/15/16