B-2016-2088CITY OF 'CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2088
21869 DOLORES AVE CUPERTINO, CA 95014-2801 (357 14 074)
SANTA CRUZ
WESTSIDE ELECTRIC
INC
SANTA CRUZ, CA
95060
OWNER'S NAME: RADHAKRISHNA CHAGANTI V AND IVATURI RADHA D
DATE ISSUED: 06/08/2016
OWNER'S PHONE: 408-218-8776
PHONE NO: (831) 469-8888
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ELECTRICAL Lic. #846294
Contractor. SANTA CRUZ WESTSIDE ELECTRIC INC Date 04/30/2017
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that 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) 23 PANEL ROOF MOUNTED PV SYSTEM (6.9 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
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
performance of the work for which this permit is issued.
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
Sq. Ft Floor Area:
Valuation: $24150.00
permit is issued.
i
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
357 14 074
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
'consequence
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in 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 pertheCupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST E INSPECTION.
Signature ,a�(/J Date 6/8/2016
Issued by: Alex VallelunEa
Date: 06/08/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License ILaw 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 (Scc.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: 6/8/2016
I hereby affirm under penalty of perjury one of the following three declarations:
for
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will maintain a Certificate of Consent to self -insure 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 Cupertino Municipal Code, Chapter 9.12 and the
a. I certify that in the performance of the work for which the permit is issued I
il
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Additionally, I devices hazardous
shall not employ any person in any manner so as to become subject tthe
material. should use equipment or which emit
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after makring this ccrtificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensa 'on provisions of the
the Health & Safety Code, Sections 25505, 25533, and 5534.
Labor Code, I must forthwith comply with such provisio s or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/8/2016
I certify that I have read this application and state that the abo a information is
CONSTRUCTION LENDING AGENCY
I
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 represeintatives 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 to
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 6 2 1
CUPERTINO
i
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELO MENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE: • CUPERTIN0, CA 95014-3255
(408) 777-3228 • FAX (1 i08) 777-3333 • building(cDcupertino.org /
PROJECT ADDRESS 21869 Dolores Avenue
Cupertino 95014
APN# j I v
OWNERNAMEChanganti Radhakrishna
PHONE 408-218-8776
E�
STREET ADDRESS -
CITY, STATE, ZIP
FAX -
Same as above
CONTACT NAME Kristi Cassetta
PHONE831-226-9363
E-MAIL kcassetta@sandbarsc.com
STREET ADDRESS
2119 Delaware Avenue
CITY, STATED, ZIP
Santa Cruz Ca 95060
FAX
831-515-5098
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # `J.2ga
Sandbar
846294
C-10JJ
`'amnp o eruz Westside Electric dba Sandbar
E M kcassetta sandbarsc.com
FAX
831-515-5098
STREET ADDRESS
Delaware Avenue'
Santa Cruz Ca 95060
PHONE3:1-469-8888
ARCHITECT/ENGINEER NAME
Sun evit
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
Sam - sholing@sungevity.com
FAX
STREET ADDRESS
66 Franklin Street Ste. 310
CITY, STATE -ZIP
dakland CA 94607
PHONE
USE OF SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial.
},�
URBAN INTERFACE AREA El Yes JpJ NO
FLOOD ZONE [I Yes ❑ NO
STRUCTURE:
ICI SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGD
G STATION
70SOL:WATERHEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: $24,150
DESCRIPTION OF WORK t
Installation of a 6.9kw rid tied photovoltaic
olar array roof mount
i
RECEIVED:BY. ,
By my signature below,'I certify to each of the fdllowin I a
the property owner or authorized agent to act on the prope
o beha I ve read this
application and the information I have provided is corr t. I h
the Description of Work and verify it is accurate. I agree to comply wi all applicable local
ordinances and state laws relating to buildin construc on. I
ize representatives of Cupertino to enter the above -identified property for inspection purposes.
Ue�ad
Signature of Applicant/Agent: t
Date:SUPPL
TAL INFO
ATION REQUIRED
� OFFICE use ONLY
OVER THE,CQUNTER
F" :'
❑ °EXPRESS
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El,MAJOR
PVApp_2011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
- - ----- - - . ... ..
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE - CUPERTIN 0, CA 05014-8255
(408) 777-3228. - FAX (408) 777-3333 7-3333 - buildirgAcupertino.ora
Permit No. B -?.n . 6--,
Address 2j869r)oi.ores Avenue Cupertino 95D 4 of Alarms Smoke: 5— .
# Carbon Mon rid
PERMIT CANNOT BE FINALED. AND (101.VM'F..-F.7F.D-TTNT1rT. Tmic i-wiDryvlrr-� A Iryp
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide arms for
compliance, with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2
where no interior i icress for
inspections are required,
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbc n
Monoxide alarms. When the valuation of additions, alterations, or, repairs to existing dwelling unit 3 exceeds
$1000.00, CRC Section R314 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
bedroom(s)
X
Contractor Name:
_tp-
On every level of a dwelling unit indu!4ng basements
X
Signature............................. ; ...................................... LIC.# ....... . .. . .......................... Dqte:
X
Within each sleeping room
X,
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage.' Carbon monoxide alarms combined" with smoke alarms shall comj.:)IY 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) maybe solely battery Dperated.
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, basemer I t or crawl
space, Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the buildingi in
wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has ave been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational; as of the date sigmed
below.
thave read and acree to comD1vwith the terms nnrlmnrlifinns of fhhz_,zfqt,-m,-nf
Owner (or Owner Agent's) Name:
Im—taill
j
Signature... ; .......... .................. .................................. Date.
Contractor Name:
_tp-
Signature............................. ; ...................................... LIC.# ....... . .. . .......................... Dqte:
...................
Smoke and COfoiwi.doc r, wised 03118114
��V►[/� WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
C11pEp11Nt>
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-x333- • building0cupertino ora
Owner Name Yerinit No.; B-20167
Address _ 21869 Dolores Avenue Ciinert nn gsnl A
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8: do not apply: Skip the rest of the form and sign: bottom of
9 No Go to Question,
uestion 2.
2. Does your real property have a Licensed plumber certifying that, due to the age or configuration of the property or
plumbing, installation of water=conserving plumbing fixtures is not technically feasible?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
❑ No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1- through 1101.8 do not apply. Skip the rest of the form and sign bottom of
F1 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and. available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8" do not apply. Skip the rest of the form and sign bottom of
;@' Yes My real property is built and available for use or occupancy on or before January 1 1994.
Civil Code Sections'1101.1 through 1101.8 apply. Check one of the three following statements and
bottom of forn..
5. Please check ONE of the following:
9 Myproperty is a single family residential real property. See Civil Code Section 1101.4..
On and after January.l, 2014, building alterations or improvements shall require all non-compliant plumbing. tures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, ll non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing, fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My properly is a nuiltifdinily residential real property. See Civil Code Section 110`1.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a co ime tial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- consei g
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtt
res will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with: Civil Code Sect
ons 1101.1
through 1,101.8, the current California Plumbing Code and California Green Building Standards Code, and manufa
turer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated
in the
table on the following page,
Owner or Owner Agent's Signature: Date: '
upon compietrng and signing this Uertrncate, please return it to the Building Division in order to final your building" ermit.
SB407 2015.doc revised 08126115