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B-2017-2128 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2128 • 22441 CARNOUSTIE CT CUPERTINO,CA 95014-3949(356 03 027) BAY AREA SOLAR SOLUTIONS INC ' PLEASANTON,CA 94588 , OWNER'S NAME: JAIRAMAN CHANDRASHEKHAR AND RAMAMOORTHY DATE ISSUED: 12/12/2017 YAM , OWNER'S PHONE:510-495-5662 PHONE NO:(925)380-9500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL Lic.#928652 Contractor BAY AREA SOLAR SOLUTIONS INC 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: INSTALL 6-50 EV OUTLET AND CHARGEPOINT CHARGING I hereby affirm under penalty of perjury one of the following two declarations: STATION. 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 „I, performance of the work for which this permit is issued. /. I have and will maintain Worker's Compensation Insurance,as provided for by Section 37.00 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500.00 • 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 356 03 027 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 .er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. //yyam� Signature,..,-- Date 12.12.17 Issued by:SEAN HATCH ."4` Date: 12/12/2017 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: 12,12.17 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 forby 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 Cod• Sections 25 05,,2553 ,aan. '5534. Labor Code,I must be deemed revoked.forthwith comply with suchprovisions or this permit shall Owner or authorized agen . k�, `'��j PY APPLICANT CERTIFICATION Date: 12.12.17 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 12.12.17 Professional \� ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION AE �SY"ySs, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIIVIQ (408)777-3228• FAX(408)777-3333• buildinqacupertino.orq PROJECT ADDRESS APN# 22441 Carnoustie court Cupertino,CA 95014 j 356-030-27 OWNER NAME PHONE E-MAIL Chandrashekhar Jairaman 510-4495-5662 _ C_jairaman@hotmail.com STREET ADDRESS CITY, STATE,ZIP FAX 22441 Carnoustie courtCupertino,CA95014 - CONTACT NAME PHONE E-MAIL '.\- trAr) . 925-380-9500f�•ThVG6,GI C'Yi� P STREET ADDRESS CITY,STATE,ZIP U FAX 111 VI \l1JU� n GIS•p 6979 Sierra Ct Dublin Ca 94568 li�/VV ❑OWNER ❑ OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE • BUS.LIC# ,a � Diana 928652 C10 J COMPANY NAME E-MAIL FAX Bay area solar solutions DBA your energy solutions Ashley.mueller@yourenergysolutions.com STREET ADDRESS CITY,STATE,ZIP PHONE 6979 Sierra Ct Dublin,CA 94568 925-380-9500 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 0 SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN URBAN INTERFACE AREA 0 Yes p No STRUCTURE 0 Commercial FLOOD ZONE ❑ Yes 0 No ❑SOLAR PANELS El ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTTER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: 5�v' __� DESCRIPTION OF WORK Install 6-50 EV outlet and chargepoint charging station. FICM.1.351 ,27s,M,P0:440;4514,mow 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 building construction, I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent`D/a i—j pts Date: Z^ j — l 7 .SUPPLEMENTAL INFORMATION REQUIREDORIIIC uSE ONLY a " t , � 3 ► vER lttt,163-uNTER a per 4 M}tcn 0*'EXPRESSs �, '`sMe a..id''m,"':_ �1 yY tet # � e It PVApp_2011.doc revised 03/16/11