14090208 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10218 PASADENA AVE CONTRACTOR:VIV INT SOLAR PERMIT NO: 14090208
DEVELOPER LLC
OWNER'S NAME: GOVINDARAJU MADHUKAR AND CHAYA M 1939 HARTOG DR DATE ISSUED:09/30/2014
OWN R'S PHONE: 4086911896 SAN JOSE,CA 95131 PHONE NO:(855)877-2974
13/ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
2J INSTALL 18 FLUSH MOUNTED ROOFTOP PV PANELS(4.86
License ClassLic.# �3 /KJ KW)
3
Contractor 0 uf+�f"Sy lQr � U/,
1 hereby affirm that 1 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:$24300
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
APN Number:35718041.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 PE SUANCE 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 F T C INSPECTION.
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 Additional) e pplivan'understands and will comp) Date:
with all non-point so rce regulat ns pe the Cupertino Municipal Code,Sectio
9.18.
11�7 0111,3 RE-ROOFS:
Signature ate / J All roofs shall be ins 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.
❑ O ER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby�r�,, that[am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
f,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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 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 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I u/Ba
gent or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by tha Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with theo Munici ode,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio5533, 4.
Section 3700 of the Labor Code,for the performance of the work for which this Q
Owner or authorized agent: Date: 1--3011
permit is issued.
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 CONS ' TIO ENDING 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
l
4 /I ALTERNATIVE ENERGY PERMIT APPLICATION
�' �I COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �D
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
WO (408 777-3228• FAX 408 777-3333•buildin cu ertino.or O
CUPERTINO I QCa p 4
PROTECT ADDRESS 10218 Pasadena Ave APN a 35 1 — It — 041
OWl'<ERNAME Madhukar Govindaraju PHONE 408-691-1896 E-MAIL madhukarcg@yahoo.com
STREET.AD DRESS 10218 Pasadena Ave CRY, STATE,ZIP Cupertino, CA 95014 FAX
CONTACT NAME Van Nguyen PHONE 408-826-1175 E-MAIL sanjosesolar@vivintsolar-com
STREET ADDRESS 1939 Hartog Dr CITY,STATE, ZIP San Jose, CA 95131 FAX
❑ OWNE7, ❑ OWNER-DIJILDER ❑ OWNER AGENT ❑ CONTRACTOR X)CONTRAC:rORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONT;?ACTOR NAME Vivint Solar Developer, LLC ! LICENSE NUMBER 973756 LICENSETYPr_46, C1 9JS LIc9
COMPANY NAME Vivint Solar Developer, LLC i E-MAIL sanjosesolar@vivintsolar.com r.Ax
STREET ADDRESS 1939 Hartog Dr CITY,STATE,ZiP San Jose,CA 95131 PHONE 408-451-9472
ARCHdTECTIENGINEER NAME LICENSE NUM31FR BUS,LICa
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
D
USE OF ❑ SFD o,Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTUR:= ❑ commer"lal URBAN'.NTERFACEAREA ❑ Yes ❑ No PLCODZONE ❑ Yes ❑ No
19 SOLAR PANELS ❑ ELECTRIC"=EHICLE_CHARGING ST.A T10N To SOLAR WATER HEATING ❑ OTHER:
FOR S01 AR PANEU.- NUMBER OF PANELSi,'NITS: 18 .Y KILOWATTSc 4 8� TOTAL VALUATION 24,300
DE50,IPTION of WORK Residential Solar Photovoltaic Rooftop Installation
FIL611 - Wounl-pW
By my;;,nature belovt,,I certify to each of the Foliowir. . (am the propert owner authorized agent tv a f I have read this
a plication and the infor Orion i have provided is co ct, 1 have read tPi owner
W rk and venf,l A is accurate. I' o comply with ail appilcable local
o-clinances and State laws relating to building const, io:3. l authorize presenta s of C per ter the above-idcry ed roperty for inspection purposes.
Signature of Appl icant/A3ent: Date' O
ENI AL -iF Rh TT01�: :,QlU D FICE USE ONLY
VER-THE-COUNTER
❑ EXPRESS
14U
❑ STANDARD
7
❑ LARGE
'MAJOR
P Rpp_2012,doc revised 06120112
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10218 PASADENA AVE DATE: 09!30!2014 REVIEWED BY: MELISSA
APN: 357 18 041 BP#: xVALUATION: 1$24,300
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE:
WORK INSTALL 18 FLUSH MOUNTED ROOFTOP PV PANELS 4.86 kffl
SCOPE
Lj _L_ Ll -L_NOTE: This estimate does not include fees due to other Departments(4e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preliminar information available and are only an estimate. Contact the Dept/or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.001= # Alternative Energy System
Supp]. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
( c)Il:S/i'acfio11 T4 Ix.
2�nifnitrativc: P c_
Work Without Permit? Yes D No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure
i
Strong Motion Fee: 1BSE1S MCR $3.16 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.001 1
SUBTOTALS: $4.16 $236.00 TOTAL FEE: $240.16
Revised: 08120/2014