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15090126-DP pub21593 LA PLAYA CT 15090126 E/P CANTWELL BRIAN A AND VICTORIA SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21593 LA PLAYA CT CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15090126 OWNER'S NAME: CANTWELL BRIAN A AND VICTORIA 775 FIERO LN STE 200 DATE ISSUED: 09/21/2015 OWNER'S PHONE: 4082210607 SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ C �.j INSTALL 31 ROOF TOP, FLUSH MOUNTED PV MODULES (8.52KW) i:� �57_0t License Class Lic. N `-' 1 GI ( � Conti le /� ate - affirm that I am licensed tinder the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in fall force and effect. Sq. Ft Floor Area: Valuation: $17800 I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self -insure for Worker's APN Number: 35623007.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN OF PERM ISSUANCE OR APPLICANT CERTIFICATION .O— .S I certify that I have read this application and state that the above information is 1 YS FRO A LED INSPECTION. 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, costs, and expenses which may accrue against said City in consequence of the granting of this pern it. Additionally, the applicant understands and will comply with RE -ROOFS: all non -point sour regulatior) the Cupertino Municipal Cod , SecI on 9.18, _ All roofs shall be inspected prior to any roofing material being installed. If a roof is / Si ' "`�C Date C4 installed without first obtaining an inspection, I agree to remove all new materials for or inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sce.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. 1, as owner of the property, am exclusively contracting with licensed contractors to California health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain construct the project (See.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25/534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Owner or auto,.ued Section 3700 of the Labor Code, for the performance of the work for which this ate: permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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 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. Signature Date CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE (408) 777-3228 • FAX (408) 777-3333 • buildlng(a cupertino.org �D O/ 2.6' PROJECT ADDRESS ,.�I / -3 C ` APN H 311 U 4 --? '` G 0 - OWNERNAME VlG�is�\Lh 1� � .` PHONE 271 mo'.. � E-MAIL STREETADDRESS pla CITY, STATE, ZIP �S'Rg�-vjj A FAX CONTACT NAME PHON '(V?- 30c U 7 2V'a E M�A[�L� - e � LQ A STREET ADDRESS 1,l .,, r- raj \ f '133CCOO-NTRACTOR CITY, STATE, ZIP �S \^ a❑,ENGINEER ❑ OWNER ❑ OWNER-BBVE.DER ❑ OWNERRAGENT ❑CONTRACTORAGENT ❑I✓ARCFBTECT ❑ DEVELOPER ❑ TENANT CONTRACTORNAME If-k~ LICENSENUMeER- 71tLe I LICENSETY��\� BUS, LICR COMPANY NAME j%'NV'� E-MAIL a `�}i ` I CC5: `) `��," FAX STREET ADDRESS 2?�`� �AG\`•' CITY, STA�T'EP 3 `�' 41' PHONE i6�� r fj��2 `�J J ARCHITECT/ENGINEERNAME LICENSENUMB£R —'-- BUS. LIC0 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WALDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ No ❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: `J r KILOWATTS(COMMERCIAL ONLY): p. a� -/ (� TOTAL VALUATION: CJ DESCRIPTION OF WORK 6ULCaII Gw%I� \� � t -.% Z \r--=AJ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act Orytls prop A ,ner's behalf, I have read this application and the information I have provid is correct, I have read the Description of Work and verify it is Vie. I agree to comply with all applicable local ordinances and state laws relating to b ' constm i K. Talrt orize representatives of Cupertino to enter the above-identi(�"aed properjy for inspection purposes. Signature ofApplicant/A Date SUPPLEMENTAL INFORMATION REQUIRED�py �0'CHU++�OJ7�'TER_q� " r: OWNE L PVilpp_2011.doc revised 03/16llI CITY OF CUPERTINO �p`y►/� FEE ESTIMATOR — BUILDING DIVISION JAFD7R7E78S: 21593 LA PLAYA CT DATE: 09/21/2015 REVIEWED BY: MELISSA APN: 356-23-007 BP#: r� j 'VALUATION: $17,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD Or DU18X USE: p PENTAMATION - PERMIT TYPE: SOLARRE i WORK INSTALL 31 ROOF TOP FLUSH MOUNTED PV MODULES 8.52k SCOPE Mech. Plan Check Ph acb. Plan Check Elec. Plan Chech Mech, Permit Fee: Plumb. Permit Fee: Elec- Permit Fee Ocher Alech, Insp. Other Pl=h Insp. Otherlile(. Insp. Ej .$lath. Insp. Fee.' Plumb, lrcy)). Fce: 81ec. Insp. Fee: NOTE: This estimate does not include fees Clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District School District. etc ). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 8 ..' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $236.00 Alternative Energy System IPKOTOVRES Photovoltaic System Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tay: Administrative �'ee: Work Without Permit? Yes � No $0.00 Advanced Plaiming, Fee: $0.00 Select a Non -Residential Building or Structure 0 • Travel Documentalion Fees: Strong Motion Fee: IBSEISMICR $2.31 Select an Administrative Item B1dQ Stds Commission Fee: IeCaSC $1.00 suHTOTAs: $3.311 $236.001 zoTAL.FEE: $239.31 Revised: 07/02/2015