B-2016-1445 PERMIT, APPCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
22561 POPPY DR CUPERTINO, CA 95014-0802 (342 12 006)
OWNER'S NAME: MANI MAHALINGAM AND VDAYALAKSHMI TRUSTEE
SANTA CRUZ
VESTSIDE ELECTRIC
NC)
'ANTA CRUZ, CA 95060
NO: B-2016-1445
ISSUED: 02/29/2016
OWNER'S PHONE: 4082521359 1 I PHONE NO: 8314698888
LICENSED CONTRACTOR'S DECLARATION
License Class C1 0 Lic. #846294
Contractor ( ANTA CRUZ WESTSIDE ELECTRIC INC ) Dale 2/29/2016
1 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,
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
'(jerfnnuince of the work for which this permit is issued.
2d 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
'1r07/� this permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
nformation is correct. I agree to comply with all city and county
lydinances and state laws relating to building construction, and hereby
n ithorize representatives of this city to enter upon the above mentioned
poperty for inspection purposes. (We) agree to save indemnify and keep
larmless the City of Cupertino against liabilities, judgments, costs, and
:xpenses which may accrue against said City In consequence of the
)ranting of this permit. Additionally, the applicant understands and will
:omply with all nor -point source regulations per the Cupertino Municipal
:ode, Section 9.18, f
Date 2/29/2016
hereby affirm that I am exempt from the Contractor's License Law for one of the
illmving two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the sir nature is not intended or offered
for sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
I. I have and will maintain a Certificate of COlnsellt to Selpiusure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade, 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 Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
a. 1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
.understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH Yn RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
INSTALL (N) SOLAR ROOFTOP MOUNTED PV (4.48ICW) - 16 PANELS
Sq. Ft Floor Area: Valuation: $15680.00
APN Number: Occupancy Type:
342 12 00G
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
PAUL O'SULLI VAN
RE -ROOFS:
All roofs shall be inspected prior to any roodng material being installed If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
Inspection.
lure of Applicant:
2 2 2016
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous matm tots requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should Iuse equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S ctions 25505, 25533, and 25534.
Owner or authorized agent:
Date: 212912016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCIIITECT'S DECLARATION
understand my plans shall be used as public records.
Date 212912016
UN
ALTERNATIVE ENERGY PERMIT
Fory 64q5
APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cuoertino.org
PROJECT ADDRESS 22561 Poppy Drive
FEN
I
342-12-006
OWNERNAMB
Mahalin am Mani
PHONE
408 252-1359
E-MAIL
mmani ahoo.com
STREET ADDRESS 22561 Poppy Drive
CITY, STATE, ZIP Cupertino Ca 95014
FAX
CONTACT NAME Krristi Cassetta
PHONE 831-226-9363
EMAIL kcassetta@sandbarsc.com
STREET ADDRESS 2119 Delaware Avenue
Santa Cruz Ca 95060
rAX 831-515-5098
❑ OWNER ❑ OWNER -BORDER ❑ OWNER AGENT
�5
ICJ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT
❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMR
S dbar
1
LICHNSENUMBER
846294
LICENSE TYPE
C-10
BUS.LIC#
-33
niaNyeruz Westside Electric dba Sandbar
E'm cassetta sandbarsc.c0m
FAX 831-515-5098
STREET2119 Delaware Avenue
Santa Cruz Ca 95060
PHONE 31-469-8888
ARCHITEC ARIGINEERNAME Sungevity
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
Sam - sholing@sungevity.com
FAX
STREET ADDRESS
Franklin Street Ste, 310
CITY, STATE ZIP
dakland CA 94607
PHONE
��66
USE OF SFD or Duplex ❑ Multi -Family
yy
El Commercial
PROJECT IN WILDLAND fi�rr,,
URBAN INTERFACE AREA ❑ Yes }y No
PROJECT IN
FLOOD ZONE ❑ Yes ElNo
,STRUCTURE:
ICI SOLAR PANELS
❑ ELECTRICVEHICLE CHARGING STATION
SOLARWATERHEATING
❑ OTHER:
FORSOL RFANEZS.- NUMBEROFPANELS/UNITS:
KILOWATTS (COMMERCIALONLY):
TOTALVALUATION: $15 680
DESCRIPTION OF WORK
Installation of a 4.48kw grid tied photovoltaic
solar array roof mount
RECEIVED BY. 0�- �y
By my signature below, I certify to each of th o wing: I am the property owner or authorized agent to act on the prop q owner's behalf. I have read this
application and the information I have pr I 's c rrect. I ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b Ild' g con u iol uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ZLLDate: 2/26/16
S11PPLtMENTALI FORMATION REQUIRED
'. OFFICE use ONLY
OVER-TIIECOUNTER
pry
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❑ EXItuess
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❑ STANDARD
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❑ LARGE
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❑ MAJOR -
PrApp_2011,doe revised 03116111