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Permit Information
Permit Number .
Status'
Master Number
Project
Apply Date'
Permit Issue Date
Certificate Issued
Certificate Type
Certificate Number
09050103
C - Closed
[� Notes
05/18/2009 ♦ Operator
06/03/2009 _ _ Operator
07/01/2009 _ _j Operator
Location Information
Address' I895 BROOKGROVE LN
City/State/Zip .CUPERTINO
APN 37539022.00
U nit
Ok,,,ner Entity Information
(Owner Name `
Use Default ❑
Address Home - 895 BROOKGROVE LN v
City/State/Zip CUPERTINO CA
Permit . Property ji Zoning 1, Applicant Contractor " Defined Fields
Permit Details Purpose/Special Conditions
Permit Type " SOLAR-RES [INSTL PHOTOVOLTAIC -
LRESIDENTIAL SOLAR PANEL
Usage Class "
N A
,NON APPLICABLE -
Applied Value "
_ 56000
SQUARE FT.
01
Calculated Value
L Q ll
US C-404 Type
434 LEI
- —
ALT: RESIDENTIAL
Permit Form '
IAUTOPERM -PERMIT v
Ownership
1 - Private
Protect Size
[EXPRESS -EXPRESS v
t
Permit issued 06J03J2009
Enter the purpose or any special conditions for this permit
FILMED- Z011
191. 1 10
10Add Default T
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Back
19;1 Contractors l
Fees J
Plan Reviews J
Inspections
Print Permit
Adjustments
[rj Holds
00 Copy Permit
Q Close Permit
I7F
, Overrides
Supplemental Fields l
,f Notes
i Attachments
C IR.
CITY OF CUPERTINO
Tka
BUILDING DIVISION PERMIT
"ftG'`3
BUILDING ADDRESS:
PERMIT NO.
895 BROOKGROVE LN
TBD - T
OWNER'S NAME:
PERMIT ISSUE DATE
PH0
A O. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
With Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full fora andeffecL'.
INSTL PHOTOVOLTAIC - SOLAR CENTER PD FOR BUS LIC
License Cl s . Lk. •
Date Contractor
.
5 / 18 / 9 ON—LINE
ARCHITECTS DECL.ARATI
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
i hereby alTirm that 1 am exempt from the Contractors License Law for the
following mason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct, liter, improve, demolWt, or repair any structure
prior to its issuance. also requires the applicant for such permit to file a signed statement
Ft. Floor Area
Valuation
that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 or the Business and Professions Code) or
5 6 0 0 0
that he Is exempt therefrom and the basis for the alleged exemption Any violation of
APN Number
Occupancy Type
Section 7031.3 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
37539022 . O O
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the worst, and the structure is not intended or offered for sale (Sec 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himselfor through his
own employees, provided that Such improvements see not intended or offered for sale If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed conuactors to
construct the project (Sec. 70", Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and .
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec. , B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, 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 Workers Compensation Insurance, as required by Section
3700 of Labor Code, for the performance of the work for which this permit is issued
performance
'
My Work s Compensation insurance and Poliry number are: )
Cartier T Policy No.: dl/ C 004", zy>
CERTi CATE OF EX PI -ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed irthe permit Is for one hundred dollars (SI00)
or Icst,)
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 Workers' Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Fscmption, you should
become subject to the Workers Compensation provisions of the ILbor Code, you must
forthwith comply with such provisions or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a conatrvctinn lending agency tar the performance of
the work for which this permit is issued (Sec. 3097, CIv. C.)
'
Lender's Name
,
Lenders Acidness
I certify that I have read this application and sure that the Shove Information is
"
correct I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise 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, costs and expenses which may in any way accrue against said City
in canseq the granting of this permit
�r
Re -roofs
Type of Roof
Signature of Applicant/Contractor ate
HAZARDOUS MATERIALS DIS LOSURE
Will the applicant or future building occupant store or handle hiumnlous material
as defined by the Cupertino Municipal Code. Chapter 9.IZ and the Health and Safety
Code. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occnpaw use equipment or devices which
emit hazardous air contaminants as fined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
1 have mad the hazardous materials requirements under Chapter 6,95 of the Califor-
nia Health & Safety Cade, Sections 25505, 23533 and 23534.1 understutd that if the building
does
All roof coverings to be Class'n" or better
0
authored agent Da
4.
oq o5 of 3:�)
CITY OF CUPERTINO
a1SOLAR PANEL
CUPERTINO PERMIT APPLICATION FORM
APN # �
n � � �
Date:
�lJ
Building Address:
Owner's Name:
License
Fax #:
Contact:
Phone #: �j c, 2-7 .20Z.00
Cu ertino Buus��ss License #:
�cl�
Fax #: Q?212 '7! �LcCn
Number of Panels/Units: Kilowatts (Commercial Only):
Job Description:
F
� * /�u ),-?o
Project Size: Express ❑ Standard Large ❑ Major ❑
Residential
Commercial ❑ Valuation (cost of project) O O
Green Points:
1.2 KW — 6 Points
❑
2.4 KW — 12 Points f!1 3.6 KW — 18 Points ❑
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
I SOLARPANL
Commercial Solar Panel
E
SOLAR-COMM
1PHOTOVCOM
Photovoltaic System
Commercial
E
1PHOTOQP
Photovoltaic Quasi
Public
E
SOLAR -QUASI
1 BSEISMICO
Seismic Commercial
E
1 ELCPLNCK
Plan Check Fee
E
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
COMM & RESID
i
/
1 SOLARRES
Residential Solar Panel
E
SOLAR-RES
Revised 01 /07/09
i