15120092 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18816 TUGGLE WAY CONTRACTOR: 'ERMIT NO:15120092
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OWNER'S NAME: AYYAR MANI AND RAJESHWARI TRUSTfp` . .t
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HONE: 4082554161 ` q
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LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION:RESIDENTIAL 0 COMMER IAL ID
INSTALL(N)ROOFTOP MOUNTED SOLAR PV-25 PANELS
License Class C -l0 Lic.# i(Ci g SSS 6 (6.5 KW)
Contractor 041P,, ,44'. t Ae Date 12—
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.
I hereby affirm under 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$25000
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. CM APN Number:37532030.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES 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. ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ( 1 ' ` A
granting of this permit. Additionally,the applicant understands and will comply Issued by: - Date: IL"
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature `r,< Date 12-- 61'"2�1y' All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection. ,
0 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 reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as 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. I will
I hereby affirm under penalty of perjury one of the 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 defined 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, ections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Date: J 'av'— �.`
permit is issued. Owner or authorized agent: yssu.� .a
I 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 Iaws 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 affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120092
18816 TUGGLE WAY CUPERTINO CA 95014(375 32 030) NRG HOME SOLAR
870 PIPER AVE
OWNER'S NAME: AYYAR MANI AND RAJESHWARI TRUST DATE ISSUED: 12/09/2015
OWNER'S PHONE:408-255-4161 PHONE NO:209-446-1381
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
C /'i.)
License Class Lic.# ?cf 9 5 5 0
Contractor NRG HOME SOLAR Date 03/09/2016 _BLDG _ELECT _PLUMB
MECH 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(N)ROOFTOP MOUNTED SOLAR PV-25 PANELS
I hereby affirm under penalty of perjury one of the following two declarations: (6.5 KW)
i. 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 REVISION#1-REDUCE SOLAR ARRAY FROM 25 MODULES TO 24
performance of the work for which this permit is issued. MODULES(6.5KW TO 6.24KW)-ISSUED 3/9/2016
diI 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:$25000.00
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 APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 375 32 030
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED IN PECTION.
Code,Section 9.18.
Issued by:ALEX VALLELUNGA ,-*. ___,
Signature Date 03/09/2016 Date:03/09/2016
OWNER-BUILDER DECLARATION RE-ROOFS;
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:03/09/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent: L.LL��CCC,,,.._�rrcc. -
be deemed revoked. Date:03/09/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 03/09/2016
CITY OF CUPERTINO
151
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18816 TUGGLE AVE DATE: 12/09/2015 REVIEWED BY: PAUL
° 1-* APN: 375 32 030 BP#: *VALUATION: $25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex PENTAMATION
SOLAR-RES4
PERMIT TYPE:
WORK Install (N) rooftop mounted solar PV- 25 Panels (6.5 KW)
SCOPE
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,f•:• P ,n<zt 11.?c I
P1,01b.h3•W n 1 other !p ;)
Ithcc/i. Imp Pr, Phrin P's,e i,,cp I ee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 •# Alternative Energy System
Suppl.PC Fee: ® Reg. 0 OT 0.0 hrs $0.00 $236.00 1PHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee: Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00 •
PME Permit Fee: $0.00
(a.'/i/strucihm 7
bee. 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
/NA ei Doi;amentation
Strong Motion Fee: IBSEISMICR $3.25 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS $4.25 $236 00 TOTAL„FEE: $240.26
Revised: 10/01/2015