B-2017-1704 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1704
998 SEPTEMBER DR CUPERTINO,CA 95014-4141(362 15 024) SUNPOWER
CORPORATION
SYSTEMS
SAN JOSE,CA 95134
OWNER'S NAME: KUMAR ASHOK AND NEELAM TRUSTEE DATE ISSUED: 10/02/2017
OWNER'S PHONE:408-772-5780 PHONE NO:(941)720-3850
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class A:B:C-10:C-46 Lic.#890895
Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2019 X 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)14-PANEL ROOF MOUNTED PV SYSTEM(5.040 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REDUCED THE PANELS TO 13-ISSUED 11/6/2017
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.
y51
it: 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:$15000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 15 024
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ` Date 11/6/2017 Issued by:ABBY AYENDE
Date: 10/02/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: 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 the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&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:11/6/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 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 Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectiosr25ft05,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall C"----.%)
� Jl
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:11/6/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDIN GENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ 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 11/6/2017 Professional
- ry
e. v =v 1
t ALTERNATIVE ENERGY PERMIT APPLICATION
,� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONA E
/,,,,, .r� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(cD-cupertino.orq •
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PROJECT ADDRESS APN# 3I a 2_ -I s-7-, 0'2_54
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OWNER NAME +' PHONE ---t 1%C.) E-MAIL
sACiSt
STREET ADDRESS CITY,STATE, IP PAX
CONTACT NAME. PHONE E-MAIL
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STREET ADDRESSCITY,STATE,ZIP FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT m-CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME .. LICENSE NUMBER LICENSE TYPE BUS,LIC II
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COMPANY NAME (,•� EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N
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COMPANY NAME . E-MAIL FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IJ- FD or Duplex ❑ Multi-Family PROJECT IN WILOLAND PROJECT IN
STRUCTURE: ID Commercial URBAN INTERFACE AREA 1----1Yes .12—Ne FLOOD ZONE 0 Yes 0 Nt(
r,-A/'
� OS
LAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK n 1 '
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T-OktiAlkelliC,CA-
By
my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ownerl 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 building construction)authorize representatives of Cupertino to enter the above-identiE' ^operty for inspection purposes.
Signature of Applicant/Agent: "tt T" Date:___ ItI(7 1A_
SUPPLEMENTAL INF0• ATION REQUIRED OFFICE USE ONLY
pw 0 OVER-THE-COUNTER
F 0 EXPRESS
❑ STANDARD
V
0 LARGE
P4
❑ MAJOR
PVApp_2011.doc revised 03/16/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1704
998 SEPTEMBER DR CUPERTINO,CA 95014-4141(362 15 024) SUNPOWER
CORPORATION
SYSTEMS
SAN JOSE,CA 95134
OWNER'S NAME: KUMAR ASHOK AND NEELAM TRUSTEE DATE ISSUED: 10/02/2017
OWNER'S PHONE:408-772-5780 PHONE NO:(941)720-3850
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
• License Class B Lic.#890895
Contractor SUNPOWER CORPORATION SYSTEMS Date 02/28/2019 X 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) 14-PANEL ROOF MOUNTED PV SYSTEM(5.040 KW)
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.
Q. - 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:$15000.00
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 APN Number: Occupancy Type:
and state laws relating to building'construction,and hereby authorize 362 15 024
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City!in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cu ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10-02-2017 Issued by:Kim Dunbar
Date: 10/02/2017
OWNER-BUILDER DECLARATION
I hereby affirm th• at I,am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons:. All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,ds 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 the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&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: 10-02-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 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'Cod'e,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
a. I certify that Iii.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 inany manner so as to become subject to the
material. Additionally,should I use equipment or devices which emit hazardous
1 , ; 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 Code,Chapter 9.12 and
exemption,I:become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 5,25533,and 25534.
Labor Code,I Inst forthwith comply with such provisions or this permit shall
be deemed'revoked. Owner or authorized agent'
APPLICANT.CERTIFICATION Date: 10-02-2017
I certify that I have read this application and state that the above information is CONSTR CTION LENDING ENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) ,
' to enter upon the above mentioned,property for inspection purposes. (We)agree .Lender's Name
to save indemnify arid'lkeep harmless the City of Cupertino against liabilities, -
judgments,costs,and expenses,which may accrue against said City in Lender's Address •
consequence of'ttie g a{nting of this permit. Additionally,the applicant understands
and will comply with all pori-point source regulations per the Cupertino Municipal -ARCHITECT'S DECLARATION
Code,Section 918. 1 I understand my plans shall be used as public records.
Licensed
Signature ; Date 10-02-2017 Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AE
ys'' 10300 TORRE AVENUE•.CUPERTINO, CA 95014-3255
CUP:ERTINO (408)777-3228•FAX(408)777-3333•buildinq(a)cupertino.orq
PROJECT ADDRESS f. APN# 3to
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY STATE,ZIp • FAX
C 9 so 19
CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FAX
uk-kLk a e,�Sk/. "�cc d CPV 9.44-3s
I7 OWNER 0 OWNER-BUILDER OWNER AGENT W�PIRACTOR 0 CONTRACTOR AGENT .0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE .BUS.LIC#
)1�V« "- 15: qs ^(a(cia,Ce46
COMPANY NAME cc,-- E-MAILr _ `ry FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX -
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STREET ADDRESS CITY,STATE,ZIP PHONE
! a' �?,aUe-S .mac �c t C cts-(34
USE OF 0 lrD or.Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA ❑ Yes ..1a-No FLOOD ZONE. 0 Yes 0 Nil'
El SOLAR PANELS I ❑ ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
Q)L\C�� $1S CX�t `a
DESCRIPTION OF WORK
\nskai...c c . <Biz
-;: moi :. • . . .
By my signature below,.I ceitify 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: C Date: (0 12(
SUPPLEMENTAL INFZbI YATION REQUIRED OFFICE USE ONLY
• . OVER-THE-COUNTER '
❑ EXPRESS
W' .
U
❑ LARGE -
.MAJOR
•
PVApp 2011.doc revised 03/16/11