10100134I CITY OF CUPERTINO BUILDING PERMIT I
I BUILDING ADDRESS: 11533 BLWCIIINI LN I CON'I'RAC`fOR: SOLARCITY I PERMIT NO: 10100134 1
I O\VNER'S NAME:
I FOS'T'ER CITY, CA 94404 I PHONE NO: (610)63&1028
LICENSED CONI'RACI'OR'S DECLARATION
License ClassC46,C h) 1 Lie.9 i�y0Contractor c
Contractor >o,_r l..M Date ?>- i-%e2r \
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury our of the fallowing two declarations:
I have and will maintain a Unifcate 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.
I have and will maintain Worker's Compensation Insurance, as provided or by
Section 3700 of the Labor Code, for the performance of the work for yyh ch this
permit is issued. __�
API'LIC, \N'1'CER'I'IFICA'1'I0N /
I certify that I have read this application and state that the above info ration 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. AddiliopptIIly, the applicant understands and will comply
with all non -point source regul0lidns per the Cupertino Municipal Code, Section
9.18. II
Date
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for one of
thelnllmving "" reasons:
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 (Sce.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contactors to
construct the project (Sec.7044, Business 3 Professions Code).
hereby affirm under penalty of perjury one of the following three
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for die performance of the work for which this
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
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CF.RTI FICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and count)- ordinances and state Imes relating
to building consuuction, and hereby authorize representatives of this city to enter
upon the above mentioned properly 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.
Date
BUILDING PER 11,11T INFO: BLDG r ELECT r PLUMB r
NIECII r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD 2.52KW ROOF MOUNTED PHOTOVOLTAIC SYSTEM
Sq. Ft Floor Area: I Valuation: $13000
ANN Number: 36658021.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued- Dale: 1: Tl
RE-ROOFS:
All roofs shall be inspected prior to any roaring material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
IIA% \RD0I1S MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safety Code. Sections 25505. 25533, and 25534. I will maintain
compliance with the Cu perlino Municipal Code, Chapter 9.12 and the Iludth S
Safely Code. Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Ray Area Air Quality Management District I will
maintain compliance1with the Cupertino Municipal Code. Chapter 9.12 and the'
llcahh &Safety C dt. Sections 25505. 25533. and 25534.
Owner (
LENDING AGENCY
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)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
1 understand any plans shall be used as public records.
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
DATE:
APN: BP #:
REVIEWED BY:
*VALUATION: 1$13,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
7OKIL
FLOOR Al ?1SA:
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
Other Plumb Jnsp. ELI
SCOPE
Ateeh, Insp. Fee:
' S
`r'zE -.ati _: .v.s'a..s- - -.—..
WEA
�3 ..
--` +v
Lf r.h. Plan Check
Plumb. Plan Cheek
Dec. Plan Chock
L1ech. Perrttit Fee: _
Plumb. Permit Fee:
Elac. Permit Tee:
Other .Mech. Insp.
Other Plumb Jnsp. ELI
Olher Ele, Insp. Li
Ateeh, Insp. Fee:
Plumb. Irtsp. Fee.,
Elec. Insp.Fee:
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee19 Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
NON
$0.00
' S
`r'zE -.ati _: .v.s'a..s- - -.—..
WEA
�3 ..
--` +v
Lf r.h. Plan Check
Plumb. Plan Cheek
Dec. Plan Chock
L1ech. Perrttit Fee: _
Plumb. Permit Fee:
Elac. Permit Tee:
Other .Mech. Insp.
Other Plumb Jnsp. ELI
Olher Ele, Insp. Li
Ateeh, Insp. Fee:
Plumb. Irtsp. Fee.,
Elec. Insp.Fee:
NOTE: These-fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 09 -051 E . 71140)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 # Photovoltaic System
$207.00 IsOLARREs
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee19 Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: 0 Yes 0 No
$0.00
0
Work Without Permit? ® Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
E)
0
i
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee :: IBCBSC
$1.00
� -
$ 2.30
$207.00 = `I'OTA][�F��E�
$209.30
Revised: 9/29/2010
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