B-2017-2134 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1 CONTRACTOR. PERMIT NO:B-2017-2134
19040 LOREE AVE CUPERTINO,CA 95014-3526(375 10 014) SYNERGY POWER
LIVERMORE,CA 94551
OWNER'S NAME. SINGH GURJOTAND JASJIT K DATE ISSUED•12/12/2017
OWNER'S PHONE.408-515-7014 PHONE NO:(866)447-9637
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class B Lic.#1025715
Contractor SYNERGY POWER Date 04/30/2019 X BLDG X 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)24-PANEL ROOF MOUNTED PV SYSTEM(7 47 KW);(N)
I hereby affirm under penalty of perjury one of the following two declarations: SUBPANEL(125 AMPS)
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.
2: I have and will maintain Worker's Compensation Insurance,as provided for by
5 t9
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area. Valuation:$24000.00
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 o building construction,and hereby authorize 375 10 014
epresentatives of thi ity to enter upon the above mentioned property for
inspection purpose agree to save indemnify and keep harmless the
ity of Cupertino.gaist liabilit' ,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
mayd accrue agai st:aidcCit conseqstands andce of the hg othis WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the apslicant, derstands and will comply with all non-point
source regulatio .per :e Cupertino,Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION
Signature .>/rf/' Date 12/12/2017 Issued by.Abby Ayende
(- / 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:12/12/2017
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 Cuper'. , Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued„I Health&Safety Code,Section 25 2'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 us•eq ipment or vices which emit hazardous
air contaminants as defined by the Ba•Area ' uality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu.erti' unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co.e,:ec ns 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: 12/12/2017
I certify that I have read this application and state that the above information is • T�J T I NI ING•
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there i r 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. !
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. / AE ALTERNATIVE ENERGY PERMIT APPLICATION
..
to...,
......, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
est tsar 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a)cupertino.orq
PROJECT ADDRESS 19040 Loree Ave Cupertino CA 95014 APN# 375-10-014
e
OWNER NAME Guijot Singh PHONE 408-515-7014 E-MAIL
STREET ADDRESS 19040 Loree Ave CITY,STATE,ZIP Cupertino,CA 95014 FAX
CONTACT NAME Jason Piekarezyk PHONE 510}18-5635 E-MAIL Permits@SynergyPower.com
SynergyPower.com
STREET ADDRESS 962 Sunset Drive CITY;STATE,ZIP FAX
Livermore,CA,94551
OWNER -0 OWNER-BUILDER - ❑ OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER- ❑TENANT
CONTRACTOR NAME Synergy Power LICENSE NUMBER1025715 LICENSE TYPE BUS.LIC#
B
COMPANY NAME Synergy Power E-MAIL FAX
Permtts@SynergyPower.com
STREET ADDRESS 962 SunsetDrive CITY,STATE,ZIP Livermore,CA,94551 PHONE
866.447.9637
ARCHITECT/ENGINEER NAME t 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
STRUCTURE: 0 Commercial - URBAN INTERFACE AREA ❑ Yes 0 No FLOOD ZONE 0 Yes 0 No
11 SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: 24.000
DESCRIPTION OF WORK Install a new 7.47.4kwdc PG&E grid tied roof mountedsolar pv system,1 sub panel
14 �j avit�
RECEIVED BY: -
By my signature below,I certify to eac f the f..,owing: 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 7Iovid•-+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 relatingl. nstruction. I authorize representatives of Cupertino to enter the aboveyidenti ed property;for inspection purposes.
Signature of Applicant/Agent: Date: 1 '' Z P /
AA
/9. PLEMENTAL INFORMATION REQUIRED
OFFICE.USE ONLY
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PVApp_2011.doc revised 03/16/11
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` KE / CARBON MONOXIDE ALARMS ti'a
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OWNER CERTIFICATE OF COMPLIANCE
,1%19 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinc a)cupertino.org
PERMIT CANNOT BE.FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,SIGNED,AND E T R +,D TO THE 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,R315,2016 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,R315, 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 the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
II
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. 04O LoceL uG Permit No. i f/'
101 i " R
Specify Number of Alarms It Smoke Alarms. I I I #Carbon Monoxide Detectors I I
i
I have read and agree to reply with the terms and conditions of this statement
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OwrGr4•caner--, . Name: Signature .. ...... ,.... .. Date: ... .. .. .
Contractor Name: t, if
p1
'� ":,, I, . u - Date: J.1�,(MI , ,,-, r Signature :e„ Lic.#
Smoke and CO forin.doc revised 01/10/2017