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15080078IN CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10951 SANTA TERESA DR CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15080078 OWNER'S NAME: DAWOOD ASHRAF AND NAYYARA 775 FIERO LN STE 200 DATE ISSUED: 08/10/2015 OWNER'S PHONE: 4082526475 SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL License Class `Z 5 INSTALL ROOF TOP, FLUSH MOUNTED 22 PV MODULES t✓ Li,, # (5.72 KW) & REPLACE (E) 200 AMP PANEL (SAME Contract l LOCATION Date I hereby affirm that I 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 Sq. Ft Floor Area: Valuation: $12000 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. APN Number: 35615009.00 Occupancy Type: 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 OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR 5SPECTION. 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 sue Date: a / with all non -point source regulations per the Cupertino Municipal Code, Section - 9.18. � OFS: Signa 2L Date to S All roofs shall be i ct r to any roofing material being installed. If a roof is installed without rrs 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: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will 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, Sections 25 059 25533 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized nt: Date: 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 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 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 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 - buildinaC_cupertino.Grg CUPERTIN r' � to al��f'•� �.(: PROJECT ADDRESS)�� ;APN#� " ®PHONES— �e ° .' -E-MAIL OWN£RNAME X STREET ADDRESS`Aee_ CTTY, STATE, ZIP �. ` Cad �FAX I�'AME �L ��f 1i"�-�� i 2�s �, A =3-c-t2ce PHONE4J 1AIL.STREET E-MAIL_CONTACT STATE, ZIP FAX 'E „Ii' r t"I"k . C .C; (W. ADDRESS®-�CITY, ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT LICENSE NUMBER ry LICENSE TYPE,, ; BUS. LIC 9 CONTRACTORNAME / ``1� vCi FAX E-MAIL COMPANY NAME f/p x� y % 1, . j I"`B`1 i p �� t I CITY, STATE, ZIP lQ , �' STREET ADDRESS f�(a i l � I PHONatQ--. ,),-' �12Z -ARCHITECT/ENGII�EERNAMELICENSE NUMBER BUS. LIC - COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO URBAN INTERFACE AREA ❑ ❑ Commercial STRUCTURE: SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: D ,� DESCRIPTION OF WORKQL_, / �� p a �� :W n By my signature below, I certify to each of the following: I amthe property owner or authorized agent to act ope vdn a]f. I have read this is I have read the Description of Work and verify it is accur ee to comply with all applicable local application and the information I have provided correct. ordinances and state laws relating to building co ruction. I a rize representatives of Cupertino to enter the a e-idghtifie : roperty for inspection purposes. Signature of Applicant/Agent: . �' •��-~- gip° " Date: (� S SUPPLEMENTAL INFORMATION REQUIRED t<.L ffcey�� YT,�Y' O5•j,5i��'w�`-k:iNssl--s^c{ gI^ .fly �.¢'q Kj. � I K4Z'H� rp.'33F•' �{h�' yTi Y9 y0 PTIApp_201 I. doc revised 03/16/11 IM-7 CITY OF CUPERTINO FEE ESTIMATOR - RUTLDTNG DIVISION Akch. Plart Check Plumb. Plan Chcd Elec. Plan Check 0.0 hrs $0.00 :Meth. Permil Fie: 1'111mb. Permi7 Fee., Elec. Permit Fee: IEPERMIT Of1wr ;t/eCh. 1nsp. ether Plumb 7rtsp. Other Elea Insp. El hrs $48.00 Mech. Inslr. Pie: Plwrtb. hrql. l`'ee.: lslec. Insp. Fee: NU1L;: 1 %tis estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District oir- )_ Thoco foot aro havod ns tho -4 nr.. _N/.. n..#I.- n--# r-. : r FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/13) ADDRESS: 10951 SANTA TERESA CR DATE: 08/10/2015 REVIEWED BY: MELISSA 1191 APN: 35615 009 BP#:Q 'VALUATION: $12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION SOLAR -RES PERMIT TYPE: WORK INSTALL ROOF TOP FLUSH MOUNTED 22 PV MODULES 5.72 k & REPLACE E 200 AMP SCOPE PANEL (SAME LOCATION) Akch. Plart Check Plumb. Plan Chcd Elec. Plan Check 0.0 hrs $0.00 :Meth. Permil Fie: 1'111mb. Permi7 Fee., Elec. Permit Fee: IEPERMIT Of1wr ;t/eCh. 1nsp. ether Plumb 7rtsp. Other Elea Insp. El hrs $48.00 Mech. Inslr. Pie: Plwrtb. hrql. l`'ee.: lslec. Insp. Fee: NU1L;: 1 %tis estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District oir- )_ Thoco foot aro havod ns tho -4 nr.. _N/.. n..#I.- n--# r-. : r FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: Reg.OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps $48.00 Electrical IBELEC200 Services Permit Fee: $0.00 Suppl. Insp. Fee -(j)0,0 Reg. C) OT hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 onstruetion Tax: T -F Administrative Fee: IADMIN $45.00 0 Work Without Permit? 0 Yes jD No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $1.56 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS' $143.56 $284.00 - ' TOTAL FEE 7 77 $427.56 Revised: 07/02/2015