The URL can be used to link to this page

09050100CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22555 CRISTO REY DR a R'S NAME: ROMAN CATHOLIC BISHOP iR'S PHONE: 4089830223 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 1 ` Lic. # 1_,�' Ga t-, Contractor T�N ISL -�NCr cAft Date 7/0'? /=, I 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. 1 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. 1 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. 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 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 indemnity 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. Additionally, the applicant understands and will comply with all non -p t source regulations per the Cupertino Municipal Code, Section 9.18.� u _ �j '`� S re '�"`� Date / y �� Q OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 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. 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating v 'Jing construction, and hereby authorize representatives of this city to enter U, ne above mentioned property for inspection purposes. (We) agree to save i 4y and keep harmless the City of Cupertino against liabilities, judgments, c(,--, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 09050100 DATE ISSUED: 07/29/2009 PHONE NO: BUILDING PERMIT INFO: BLDG T_ ELECT PLUMB MECH f— RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: PHOTOVOLTAIC SYS INSTALLATION nNON- 'ROFIT 2EMETARY iq. Ft Floor Area: kPN Number: 34263002.00 Valuation: $322830 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ` _�7 `� Date: 2.Z�i,<� RE -ROOFS: kll roofs shall be inspected prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection, 1 agree to remove all new materials for nspection. signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain -ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & safety Code, Section 25532(a) should I store or handle hazardous material. Wditionally, should I use equipment or devices which emit hazardous air -ontaminants as defined by the Bay Area Air Quality Management District I will naintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the lealth & Safety Code, Sections 25505, 25533, and 25534. 6'eor authoted ent• 471/� 1 Date CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's or which this permit is issued (Sec. 3097, Civ C.) ender's Name .ender's Add ARCHITECT'S DECLARATION understand my plans shall be used as public records. Signature Date I .icensed Professiona CITY OF CUPERTINO SOLAR PANEL [�ERMIT APPLICATION FORM APN:4 Date: Building Address: Owner's Name: Phone V-1 —_ X2�,Vt _0 9 Contractor: Phone 611po Contractor License 4: V '60 ns. TZin C, Fax #: Contact: Phone #: 4o?,- 3vik Cupertino Business License 4: Fax #: Number of Panels/Units: Kilowatts (Commerc• ial Only): qVI 15(L (0 Job Description: Project Size-. Express Standard Large Major Residential Commercial Valuation (cost of project). Green Points-. 1.2 KW — 6 Points El 2.4 KW —.12 Points El P-N-No'l- MO 3.6 KW — 18 Points■ Quantity Fee ID Fee Description Fee Permit Type Group ISOLARPANL Commercial Solar Panel E SOLAR -COMM IPHOTOVCOM Photovoltaic System E Commercial IPHOTOQP Photovoltaic Quasi E SOLAR -QUASI Public I BSEISMICO Seismic Commercial E lELCPLNCK Plan Check Fee E IBCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee COMM & RESID ISOLARRES Residential Solar Panel E SOLAR -RES Revised 01/07/09 ITEM 1 OF 1 PERMIT RECEIPT OPERATOR patg COPY # 1 Sec: Twp-. Rng: Sub: Blk: Lot: APN 64999640: 34263002.00 *ATE07/29/2009 RECEIPT # ........ BS000008314 REFERENCE09050100 SITE ADDRESS 22555 CRISTO REY DR SUBDIVISION ...... : CITY ............ .: CUPERTINO IMPACT AREA ....... 0 OWNER ............. 9 ROMAN CATHOLIC BISHOP ADDRESS CITY/STATE/ZIP ... : LOS ALTOS, CA 94024 RECEIVED FROM ..... . JAMES S COATES CONTRACTOR ........ * TBD - TO BE DETERMINED LIC # 00096 COMPANY ........... a TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 322,830.00 ---------- 13.00 ---------- 13.00 ---------- 0.00 ---------- 0.00 lBSEISMICO VALUATION 322,830.00 67.83 67.83 0.00 0.00 1PHOTOQP EACH 1.00 1018.00 1018.00 0.00 0.00 1SUPPKFEE HOURS 1.00 126-00 0.00 126.00 0.00 TOTAL PERMIT ---------- 1224.83 ---------- 1098.83 ---------- 126-00 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD I W."Imlaklimaimsm AMOUNT --------------- 126-00 --------------- 126-00 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 1 20101 06. Ak MjVljjjff��j U REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL • 16 6, "wm0)QKft$j 'vy"wro 0 ia " w Sec: Twp.- Rng: Sub-, Blk: Lot: APN 34263002.00 DATE ISSUED ....... 05/18/2009 RECEIPT REFERENCE ID # ...-f 09050100 SITE ADDRESS 22555 CRISTO REY DR SUBDIVISION CITY ............. CUPERTINO IMPACT AREA ...... OWNER ............ : ROMAN CATHOLIC BISHOP ADDRESS .......... : 22555 CRISTO REY DR CITY/STATE/ZIP ...: LOS ALTOS, CA 94024 OPERATOR suew COPY 4 1 m RECEIVED FROM .... : JIM COATES CONTRACTOR ....... : TBD — TO BE DETERMINED LIC # 00096 COMPANY ........... a TBD — TO BE DETERMINED ADDRESS .......... : CITY/STATE/ZIP ... : TELEPHONE ....... FEE ID UNIT QUANTITY AMOUNT PD—TO—DT THIS REC NEW BAL ---------- ------------- 1BCBSC VALUATION ---------- 322,830.00 ---------- 13.00 ---------- 0.00 ---------- 13.00 ---------- 0.00 lBSEISMICO VALUATION 322,830.00 67.83 0.00 67.83 0.00 1PHOTOQP EACH 1.00 1018.00 ---------- 0.00 ---------- 1018.00 ---------- 0.00 ---------- TOTAL PERMIT 1098.83 0.00 1098.83 0.00 METHOD OF PAYMENT ----------------- C,V E D I T CA VD 14102y.I AMOUNT --------------- 11098.83 --------------- 11098-83 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL lillil I 1�jj� REFERENCE NUMBER -------------------- VISA CHASE VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL