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B-2016-1181 Permit Application
CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingdOcuoertino.orG AE PROJECT ADDRESS /OS9 WeCr IR L 7— pJ OS( OWNER NAME �1"PN PRONE ©jJar Ic✓ / / ' d 6 b _,•�,� GY0.UIL SCV LA'7^- STREET ADDRESS/O s9 lA/ T a coux-r CIn - J06X71A1OTATE, ZIP 24 5,01 FAX CONTACT NAME Mark Londre PHONE (408)289-9725 I E-MAIL office@willow lenelectric.com STREET ADDRE' O. BOX 8430 CITY, STATE, ZIP San Jose, CA 95155 F"X (408)289-9725 ❑ OWNER ❑ OWNER -BUILDER OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ,,1❑ CONTRACTOR NAME Mark Londre LICENSE NUMBER 591918 LICENSETYPE n-10 1 BUS.LICR 15897 COMPANY NAME Willow Glen Electric, Inc. E-MAIL office@willowglenelectric.com FAX (408)289-9725 STREET ADDRESS P. O. Box 8430 CITY. STATE. ZIP San Jose, CA 95155 PHONE (408)289-9725 ARCHITECT/ENGMEER NAME NSA LICENSE NUMBER BUS. LICIT COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FORSOIARPANELS. NUMBER OF PANELSIUNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION:/1 .s DESCRIPTION OF WORK ,,....Lr . Electric Vehicle Char in Circuit: �S !� (�) iZ sA �> aytc2 �1�rfiux.moxhYcd) Iieiuii�aL /1'�Gf1. eQe.et�Lrtw C �ane-Q - a�-� (!) a210 Yo-et dcdccuYc d Gu.Uc A/a- sw fu �e�m �Twu,Fed �f/�xrA �Sl �v ys�t lc . d u.e ` YAe, tw •�u u a4e2 k1Z `� a-ca e )40 -ems L4 4todd S . RECEIVED BY: � d By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I havtvaidAhis application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con meR^� .eAhq/�6Yes of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantlAgent: � I \ / , Date: 1 — 6 —IL/O SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-TH4COUNTER 4 �' ❑ EXPRESS Y ❑ STANDARD u ❑ LARGE ❑ MA10R PVApp_2011.doc revised 03116111