15080043CW?
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7561 BOLLINGER RD
CONTRACTOR: HIGHLIGHT SOLAR PERMIT NO: 15080043
OWNER'S NAME: FERGUSON GERALD AND AGNES
3554 PARKLAND AVE DATE ISSUED: 08106/2015
OWNER'S PHONE: 4159903398
SAN JOSE, CA 95117 PHONE NO: (408) 489-9273
PI-11, LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE]
INSTALL 18 ROOF TOP, FLUSH MOUNTED PV MODULES
License Class Lie. #
(4.59 KW). REPLACE (E) 125 AMP MAIN ELECTRICAL
Contractor HI t I Date
&r—_ 0 6 t2O
PANEL, SAME LOCATION
1 hereby afar that I a 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
Sq. Ft Floor Area:
Valuation: $19000
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
APN Number: 35922046.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I 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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS QFYJq�RMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
�FR
costs, and expenses which may accrue against said City in consequence of the
granting of this permit, Additionally, the applicant understands and will comply
Issued Date: 10 . CV.
with all non-point source regulations per the Cupertino Municipal Code, Section
9,18.
RE- ROOFS:
Signature Date tg��/ j
All roofs shall be inspected 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044. Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section P 5505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:O ff-041W40A
permit is issued.
I 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
CONSTRUCTION LENDING 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
Lender's Address
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
PROJECT ADDRESS j 1 B011 4 y) fi
Ro aok_
APN 4
OWNERN�&MB
PHONE E-MAIL
910
C
STREET ADDRESS
56 ! BOW, 10-0r�
CITY, STATE, ZIP
CK- 950)L4
FAX
CONTACT NAME
Pad, Y) e h LC'yle
L PH�NBL(OF
_j,8q_j;Lj5
--KAIL
I F LC' V 1,
STREET ADDRESS
�) liflL'V-1.4
k\j—
CITY, STATE, ZIP
1 5&'V1 C A q 6'11--�-1 1
FAX U
El OWNER ❑ OWNER-BUILDIUL OWNER AGENT
X CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER 0TENANT
CONTRACTOR NAME M. V
LICENSE NUMBER
-4�- -:H
C SE TYPE C Ll
BUS. LIC #
COMPANY NAME <
E-MAIL PACILI&71.� 6��, Qt�-�\Ar. Cc,,
FAX
STREET ADDRESS
V,
CITY, STATE, ZIP
S C'
PHONEI
ARCHETECTIENGINEER NAME
LICENSE NUMBER
BU& LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family
STRUCTURE: 0 Commercial
PRO= IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
�RSOLAR PANELS
ELECTRIC VEHICLE CHARGING STATION
SOLAR WATER HEATING
onmp-
--------------
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: 191
DESCRIPTION OF WORK
k-,l gli
mct-k V1 ct,
T
h
By my signature below, I certify to each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have prqvided 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 b * ing construction. I authorize representatives of Cupertino to enter the above•identifled Dro erty for inspection purposes,
Signature of Applicant(Agent: _ Date:
IUPPLEMENTAL INFORMATION REQUIRED
PTIADo-2011.doc revised 03116111
A,Jech, Man ("YwCA-,
et?"
I Otkwr 140%11 lnsp,.
l'Ict 2i1, Ilan 'heck
Other Numb
I'lurni, lrisp
Fhmqb, Pe;wul !`(,e:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: ]EPERMIT
Other Elec. Insp. 0.0 hrs $48.00
hlle,, Ins"o. Fe"'!
NUT E: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
,Vistrict, etc.). I ftese fees are based on the preliminary information available and are only an estimate. Contact the Dept for addnl into.
FEE ITEMS (Fee Resolution 1.1-053 Eff L/l/13 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $236.001 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00 DTI amps Electrical
Permit Fee: $0.001 $48.00 IBELEC200 Services
Suppl. Insp. Fee-(j) Reg. 0 OT [w] hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.001
("onsirm"lion 7,xv:
I
I
I
I
Administrative Fee: 1ADMIN
$45.00
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non-Residential 0
1 Building or Structure 0
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$2.47
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SURTOTALS,:
$144.471
$284.00L, TOTAL, F]
28:4:7
Revised: 0710212015
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