B-2017-1470 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1470
19680 DRAKE DR CUPERTINO,CA 95014-2434(316 32 023) GREEN POWER
INSTALLERS INC
SANTA CRUZ,CA
• 95060
OWNER'S NAME: KOTTE MURALIKRISHNA RAND MURALIKRISHNATHI DATE ISSUED:09/05/2017
OWNER'S PHONE:408-615-1558 PHONE NO:(408)615-1558 •
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#952145
Contractor GREEN POWER INSTALLERS INC Date 09/30/2018 9/5/2017 BLDG _ELECT _PLUMB
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
license is in full force and effect. JOB DESCRIPTION:
(N) 16-PANEL ROOF MOUNTED PV SYSTEM(5.36 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
[E'' 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. Sq.Ft Floor Area: Valuation:$18000.00
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 APN Number: Occupancy Type:
and state laws relating to building;construction,and hereby authorize 316 32 023
representatives of this city to enf&upon the above mentioned property for
inspection purposes. (We)agreeko save indemnify and keep harmless the ,
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said'City consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant u .er�.sand will comply with all non-point
source regulations ea .1W.,.:-:t7, Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. .
'I
Sig b,ii Aff '� Date 7 5-/ 7 Issued by:Jasmine Archbold
r.. >'e r :, Date:09/05/2017 --- - ..
O.► .i-BU r_Rt :41_, e
I hereby affirm that I am:exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: , 'I All roofs shall be inspected prior 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 obtaining an inspection,I agree to remove all new materials for
compensation,will do tli work,'and the structure is not intended or offered for inspection.
sale(Sec.7044,Business'AL-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:
I hereby affirm under penalty of perjury;one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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. HAZARDOUS MATERIALS DISCLOSURE
z. 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&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued, maintain compliance with the Cupertino,Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 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,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal .'de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio s 25505,25 . ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall .
be deemed revoked. r ,
e�_or authorized agen : rpr
APPLICANT CERTIFICATION I certify �
CON TR I. TIONllllal►`it�AGENCY
correct. agreeIht to comve ply with all cithis ty
oandn nd eolyd oat rdinances and state laws ise above information I hereby affirm that there is a cd— lending agency for the performance
comply county of work's for which thispermit is issued Sec.3097,Civ
relating to building construction,and hereby authorize representatives of this city ( 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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
' Licensed
Signature Date Professional
\\ / ALTERNATIVE ENERGY PERMIT APPLICATION
VCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AE
40ST,iPs, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIIdO (408)777-3228•FAX(408)777-3333•buildinci cupertino.orq
PROJECT ADDRESS/VO r 1 r �� i� APN#
JJ J l /Y 1J
OWNER NAME j�A f tr 71 r K,-�F-� PHONE �g ((`-(..:54--is ,
/� E-MAIL
STREET ADDRESS %? �l�O f -ILC CITY,STATE,ZI� n ic[ - /1 Q FAX
CONTACT NAME j///2 6 Ck /// /1c? PHONE,/, 44,//''++++
CI) -MAIL
STREET ADDRESS /, �� �n �� CITY,STATE,ZIP Cid r-e� FAX
❑OWNER ❑'l OWNER-BUILDER,v0 OWNER AGENT `CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR N Ere�� i� �:�% //k/LICENSE NUM$E$`/ `/ /5 LICE TYP E BUS.LIC#1'22
_
COMPANY NAME Kf!(�/ E-MAIL(/ lLL FAX
�S+�7C
.�► �1/2.5.167/42,/,
l rj.14 4/j
STREET ADDRESS Q� A/w��icn ^ CITY,STATE,ZIP�a 1L C( 'I� PHONE/�G T"I J 1
ARCHITECT/ENGINEER NAME �) LICENSE NUMBER (6) 1 -1 BUS.LIC#Q
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF If SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA 0 Yes ElNo FLOOD ZONE 0 Yes 0 No
I
.SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: Se9/6
KILO WATTS(COMMERCIAL ONLY): TOTAL VALUATION:A. !� /v
DESCRIPTION OF WORK 3 `4 ] r Z j_ /I r /
CC, . (� tE
.
�R^E ETVEDBYi.-�
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act one propertyowner's beh lh f. I have read this
P P Y g
application and the information I h e provide t rree ..e ve read the Description of Work and verify it is accurate. I gree to comply with all applicable local
ordinances and state laws relatin_. o building construction`I'. oriz-representatives of Cupertino to enter the abo -i ntifted p 'perty for inspection purposes.
Signature of Applicant/Agent: Date: __.5 /
SUPPLEMEN-AL IN •RMATION REQUIRED l /, - OFFICE. USE ONI Y
"0 OVER-THE-COUNTER, 5
E" 0 EXPRESS . 1="
x 0 STANDARD" --
U.
at
a. ❑ LARGE'
'w D MAJORS ,
PVApp_2011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE 2 iria
;;Prea, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
..
w ,tea
CUP RTIh1E3 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• building a(�cupertino.orq
ask 3 "3 ter ' c
PERMIT CANNOT BE FINALED 17NTIL THIS CERTIFICATE HAS BEEN
-rCo 'LET D,SIGNED,AND RETURNED TO THE BU LDING DIVISIONS �
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 907.2.11.4 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: / Permit No. J7 /Ai7�
Specify Number of Alarms: #Smoke Alarms: I 3 I #Carbon Monoxide Detectors:.I I
I have read and agree to comply with the terms n conditio iff this statement ,
Owner(orlOwner Agent's)Name: 1 ( e—�- c¢
Signature "" ``�� Date:
l/27�`7
Contractor Name`.
Signature... Lic.# 1:1 i-7 Date: 9/'e7//7
Smoke and CO fonn.doc revised 12/15/16