13100072 MY OF CU P]E][8UNO BUMI DE NG ]PIERMffT
BUIILDING ADDRESS: 11518 CHARSAN LN CONTRACTOR:SOLARCITY PERMIT NO: 13100072
OWNER'S NAME: SU PHILIP AND CHEN MICHELLE MEI LIE 3055 CLEARVIEW WAY DATE ISSUED: 10/10/2013
OWER'S PHONE: 5105790049 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lic.# �6INSTA]L]L PV SYSTEM ON ROOFTOP 8 PANELS,2]KW
Contractor Date [0/10/13
I hereby affirm that I am lice, d under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&c 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:$8000
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:36210069.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICA'T'ION
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 ���®�PERMIT ISSUANCE ®�
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 DA OMI]LAST CALLED )INNSPE TION.
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. Additionally,the applicant understands and will comply Issued by: Date: �/
a non-porn u ations per t r upertino Municipal Code,Section
.18. /
RE-ROOFS:
Signatur Date b f / 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
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)
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&c 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&c 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 Cu ertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&r Safety C , ections 20",and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this I
Owner or auth
permit is issued. a ate:
I 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 California. If,after making this certificate of exemption,l CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,l must l 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 l 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 l 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
cCRTY OF cCUPER TING
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 11518 charsan In DATE: 10/10/2013 REVIEWED BY: Mendez
APN: IBP#: OOO�A *VALUATION: 1$8,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMIT TYPE: SOLAR-RE
WORD install pv system on rooftop 8 panels, 2kw
SCOPE
lfech. flan Check Phimb. Plan C'ltctc`k Stec.Plan Check
Xfech. Permit Fee: Plumb. Permit Fee: Eter... Pcrmir Tee:
Other Afech.Insp, . Other Plumb Insp. C Other Elec.Insp. Lj
,Vcch.Insp. Fee: Plumb. Insp.Tee: Eley.Imp,Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are on! an estimate. Contact the De t or addn 7 in o.
FEE ITEMS(Fee Resolution 11-053 EfT 7/1113) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Supp/. Insp. FeeQ Reg. OOT 0.0 hrs
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tarr: C
Adininistrative Fee:
Work Without Permit? 0 Yes (D No $0.00 1 E)
Advanced PlanninL Fee: $0.00 Select a Non-Residential E)
Travel Docznnentalion Fees: Building or Structure 0
Strong; Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 Ll
SUBTOTALS: $1.80 $229.00 TOTAL.FEE: $230.80
Revised: 10/01/2013