B-2016-2797 CITY OF CUPERTINO BUILDING PERMIT
BURDINGADDRESS: CONTRACTOR: PERMIT NO:1112016-2797
22701 STEVENS CREEK BLVD CUPERTINO,CA 95014-5628(342 12 025) SUNRUN
INSTALLATION
SERVICES INC
SAN LUIS OBISPO,CA
93401
OWNER'S NAME: WALIA SUNIL KAND VENKATARAMAN RAMYATRUSTE DATE ISSUED:.09/26/2016
OWNER'S PHONE:408-887-7771 r PHONE NO:(415)580-6900
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lic.#750184
Contractor SUNRUN INSTALLATION SERVICES INC Date 06/30/2018 X BLDG _ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: (N)19 PANEL ROOF MOUNTED PV SYSTEM(5 KW)
1. 1 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.
C_ 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. Sq.Ft Floor Area: Valuation:$10450.00
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 to building construction,and hereby authorize 34212 025
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting all
this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,t e appli nt � drstands and will comply with all non-point
source regul ions p t + pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
-Sinaturei
g Date 9-26-2016 Issued by:Kim Dunbar
Date:99/26/2016
- ,CLARATION
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
t. I,as owner of the property,or my employeeswith 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:9 26-2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
x. 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 Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)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 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C pertin iM ci {al Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code:Sectio sf25 0 5533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall//
be,deemed revoked. (,.O er or authorized agent:
APPLICANT CERTIFICATION Date:9-26-2016
I certify that I have read this application and state that the above information is CON ,'/ LY`rV
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction ending 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. 1 understand my plans shall be used as public records.
Signature Date 9-26-2016
Licensed -.
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIINO (408)777-3228, FAX(408)777-3333•buildina(a-.cupertino.org
C " 7
PROJECT ADDRESS 5x3 1) I guz
APN 9
OWNERN AMES PHONE.. E-MAIL
S I \NAU o 1
STREET ADDRESS CITY, STATE ZIP FAX
allz+w L�F—\Ir-Ns' LgL7'y-- lojCA 615DIq
CONTACT NAME. PHONE _ E-14AIL T S' I'.69V—L.j
,oM _IL X eta e
STREET ADDRESS CITY,STATE ZIP FAX
2 � � - 3 30SE C* 0 S1 i
❑ OWNER; ❑ OWNER-BUILDER ❑ OWNER AGENT S/CONTRACtOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME "p(� ' f LICENSE T ;E�R LICENSE TYPE q` BUS,LIC#-T
^�
COMPANY NAME RAO,!i PP"EE-MAIL FAX I
STREET ADDRESS `A } CITY,STATE,ZIP PHONE
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS,LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS �✓ CITY,STATE,ZIP PHONE
USE OF E] SFD Or Duplex -Zmulti-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
U SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: IrA
KILOWATTS(COMMERCIAL ONLY) TOTAL VALUATION: . SO
DESCRIPTION'OF WORK
T
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ovner's behalf. I have read this
application and the information I have provided is co. ct. 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 build's g const' ctio . au r hize representatives of Cupertino to enter the above-ide ttifted pr perty for inspection purposes.
7
Signature of Applicant/Agent: �' ��- Date: p
SUPPLEMENTALORMATION REQUIRED
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inspeckions arc rehired;.
Existing-single-family and multi-family dwellings shall be pro-vided with Smoke Alarms and Carbon
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+AWN CERTIFICATE O OMPL ANCE
COMMIJINJITY131.�VELOPMEN!'Q1=0AE"tTMENT•Bt11i_DINfa DIVIS'10 it
' L7 ER�(t*C� 1D3ODTOf REAM=hlt1Bi CUPERT[90 CA 5014 3265
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Address Z #s _s� e, rteI Ile,
1. Ts your 1ea1 property a registered histoical site?
YeaCivil Csidc`flection 1101.1 through I 1{}l:8 oo.not apply iSkipe rest o e forte arrd sib bdttoaf dorm..
IN No Qo to Questioti 2•.
2'. I ces'+ourf�al prpper=ty have a lre-n "d plurrri er eek fym�tha#,diet t a e car ars i ur t2e n of'ills prc±pe °c� i
plun�bi rg,rnstallatiori of watconservm' g pliunbrr g Mures is not teclinically feasible?
�'es Civil Cede Seetiairs l 10I,I"�througl I101,8 do trot apply.
11 'The licensed plurtrbei's certr loaOon;k% beert. roirided is rise l taildirr rvrsro�aE .
'Skip the t t of"th,fgrm and 49 rbottom.of form.
® 6 Skip
Question I
a, Is water seri lce permancntlyr disconnected.frit your'liiiildiiig?`
® 'esu Crvil Code Sections 11Q1.11hrough 11011 do not applyr Slip th r ttif.t e fo .aod sign bottom of`for
12 No, Go to Question 4
4. Is your real property built and available for-use or occupancy on or before.January If:1994?
D No My real property is,built arid.awilab-e for use or oceupancya-1�ter unitary 1,1994i
Civil Code Sections 11 tf 1.1 through 1101,8 dee not aplsly_ Ship the rest-of the form and sigt-bottoin of-fd
M Yes Mv real property is built and 4vail$ble f'ortse or oceupancy ort or before January 1;199#:
Civil Code ectaons l MA fhro4h 110118 apply: Check oiae of thc.tlarec follo�vi r taterr eh :and�iigt
bottom of form..
5. Please clreclti.tll�lE of'the fallowing.'
M}�prope is nsi glo fans�ly t z �tlxajr at pro erty. Sed Civil rOde Section li3Ol�f
Qzt aid amt Jrtuary 1, 014 braildulg sitexatrons or improve shall requrre all r�orRcorrrpliant pt tures
to be replaced with gator-d serviri plumbing fixi�ares"tlrrcitxgIrout the brifidrng flu or befa Jauuarlr �. Cil7,Ono
corrzpliant plprrtbirrg Mures shall be •replaced with water.coriservsiig, piurrihi t t (x ardlcgs of vl ekhea
propertyigidergoes alterations or irrzprovenients .
D Mygrope,.,is a mr l-1,-wy r�sirWWfal realproperEy dee Civil Cade Section 11 1 i;
Can and afteP 3anuary 1,2014,specified buiIdio9 ' ratioxr or irnpr0rrernents slialllregrure f or%,cd pliant
plumbing fixtures to.be replaced with water-censer g pltlttming'fixtui6s.
C?r or befo:q;7airvary 1, Ol ,all rrarr=cis pMntplumliing fixtures shall l�e;replaced with Viief
:
06ngervrrrg pium,bing fist±ares throu. csutthe building(regardless of whetherpr rpert!1 i Q s altcratio s or:
imprbvermnt ,
El My grope, yis'a eott nercia rea-woperty. SO Coils Secti+sn'1101, .
011 and a f ter 7anusly 1,2014,specified building alttic ,or impr6vertlerats shall requiie r<on-oorrpIiarit
plumbing fixtures to be replacers with water-cc er a pI in- fixtures.
CSrt or before January1, 2t}19, sil nor%ebpipliant plumbing frxtufes shall be replacers wrm water eonseTv"
laiun Bing ti lures tl rorsgboi t t ebuildirig(egaidless of whethef propeify undergge�altO446 rs r imps oveiueritsl
1,astlydownertrr.owmer'sagentof`thisproperty;certifyunderpenaTtyofpe u tkaataeon-ctsrriplianipluxnbin xtuces srillbe
replaced prior to date specified above Vrith;waterconserving plur nbing Mures in accgrdance with Civil Code Sections 1101.1
through 1101.$ the curxent California Plumbing Code;and Cgliforrtia Car en l uildirr tandarcls Coda and ttr tr factilrer's
in requiremer2ts;and that,thew$ter-c in e i tg pl aabur f kur es carr ply with the requ rerrieut as i tli ated in the,
D"Usigned�bY: - .
table on the followingpage.,, -
Cw11ef or.Pvttlar,Atgeut's:SWnaturo:
'Upor cornpleting and signing this Certiftof plr�se return Kto the Building DivisioYr irr order to final your building permit:
2007 M5 doc:)-e sed 08126115