15070159-DP1574 JAMESTOWN DR
15070159
F/P
BALUSU MADHAVI AND PRASAD
SCANNED BOX #663
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1574JAMFSTOWN DR
CONTRACTOR: BALUSUMADHAVI AND
PERMIT NO: 15070159
PRASAD
OWNER'S NAME: BALUSU MADHAVI AND PRASAD
1574 JAMESTOWN DR
DATE ISSUED: 07/22/2015
OWNER'S PHONE: 4084222600
CUPERTINO, CA 95014-5313 PHONE NO
0 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERjIALE]
INSTALL NEW SOLAR MOUNTED - 20 PANELS (5.20KW)
License Class- Lic.
AND
INSTALL NEW 200 AMP MAIN PANEL
Contractor Date
I hereby affirm that I am licensed trader 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.
I hereby affirm tinder 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
Sq. Ft Floor Area:
Valuation: $30000
performance of the work for which this permit is issued.
1 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.
APN Number: 36610072.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRE, S IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPE�TIO
indemnify and keep harmless tire City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Dati
with all noti-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaming air inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two rensons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, mid the structure is not intended or offered for sale (Sec.7044,
siness & Professions Code)
?B
, owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code),
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will
I hereby affIrm under penalty of perjury one of tire following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as deflned by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section A 25505 1 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner
is issued.
or authorized agent: Date:
V
Zfint
cemrfify that in the performance of the work for which this permit is issued, I shall
not employ any person in my manner so as; to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirin that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shalt be deemed revoked,
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Leader's Address
I certify that I have read this application mid state (list the above information is
correct. I agree to comply with all city and county ordinances 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 City of Cupertino against liabilities, judgments,
ARCHITrCT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the appliCaut understands and will comply
with all non -point source regulations per tire Cupertino Municipal Code, Section
Licensed Professional
9.18
Signatir,A Dat -_7 5,
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingacupertino.org 15D�0151
PROJECT ADDRESS p;7it :�4M
APN.
tV 4A P(wt;n,
OWNER14ANIF -2
PrOA RcthOk
STREET ADDRESS
'LmPj+,qw0
CITY, STATE, ZIP
FAX
11;74
CONTACT NAME
PHONE
F -RAIL
STREETADDRESS —
07* Imp-j:bom
CITY, STATE, ZIP
FAX
OWNTR El OWNER -BUILDER. ID OWNBRAGENT 11 CONTRACTOR ID CONTRACTOR AGENT El ARCEFFECT El ENGarEER El DEVELOPER 0 TENANT
CONTRACTOR NAME
LICENSENUMBER
LICENSETYPE
BUS, LIC
COMPANY NAME
=14AIL
FAX
SIMI ADDRESS
----7CENSE
CITY, STATE, ZIP
PHONE
ARCMTECT/FNGrNEER NAME
NUMBER
BUS. LICO
COMPANY NAME
[E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHON12
USE Of '12� or Duplex E] lviulti-Farnily
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE E) Commercial
URBAN INTERFACE AREA El Yes No
FLOOD ZONE El Yes P�No
SOLAR PANELS
El ELECTRIC VEHICLE(IFLARGING STATION
I El SOLAR WATER HEATING
El OTHER:
FOR SOLAR PAAWLS' NUMBEROFPANELSIUNITS: KILOWAT- IS (COhiMERCIAL ONT-10:
20
TOTAL VALUATION:
DESCRIPTION OF WORK
;;/�7kffiij .70 9,&-r P*V
�II* f�'o A
gog
By my signature below, I certify to each of the following: I am the property oVTer or authorized agent to act on the property ol�qner's behalf I have read this
application and the information I have providcd is correct, I have read the Description of Work and verity it is accurate. I agrae to comply with all applicable local
ordinances and state laws relating to b IdIngCOnstruc) . on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/A.g I - — Date:
SUtKEI\IENTAL TNFOn4ATION REQUIRED
'o-
�Ri3—
I —�4w
wm-
IJ
Ta
PJ`.4ppj0J I. doc revised 03116111
&I
CITY OF CUPERTINO ) e�040 S�
FM -1 FEE ESTIMATOR - BUILDING DIVISION
WFjD7R7E7SS:
1574 JAMESTOWN
DATE: 07122/2016
7T17E7W7E71) BY: PAUL
I APN:, 36610 072
BP4:
I *VALUATION:
1$30,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
Elee. Insp. bee:
PENTAMATION
PERMIT TYPE: SOLAR -RES
$0.00
w solar mounted - 20 Panels (5.20KW) and Install new 200 Amp Main Panel
ISE=
$0.00
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seiver District, School
District,etc.). These fees are based on the Preliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff, 711113)
,Wvcb. Plan
Hand), Wan Chrelt
Elec. Plan Check 0.0 Irrs $0.00
I/Ilumb. pe,mt [w:
I Flec. Peralit Fee: IEPERMiT,
Other rVech. fasp
Other alwab /Par, Lj I
Other Elec. Insp. 1 0. 0 1 hrs 1 $48.00
illech, Insp- bee:
Phaah. hap. 1,ae�
Elee. Insp. bee:
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seiver District, School
District,etc.). These fees are based on the Preliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff, 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.001
Alternative Energy System
IPIYOTOVRES Photovoltaic System
__F0
Suppl. PC Fee: 1@ Reg. 0 OT
—1—
.0
Ins
$0.00
PME Plan Check:
$0.00
F200� amps
$48. 00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee -.I@ Reg. 0
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tcu:
Administrative Fee: 1ADMIN
$45.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Feq�.
$0.00
I==
Select a Non -Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee* IBSEISMICR
$3.90
1
Select an Administrative Item
I
Bldg Stds Commission Fee: IBCBSC
$2.00-_�
SUBTOTALS:
$146.90
$284.001
TOT,�.� FEE -1
$430.90
Revised: 07/0212015