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15040153-PUB20766 FARGO DR 15040153 F/P ERIC CHANG & MINH HWAI CHENG SCANNED BOX #596 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20766 FARGO DR I CONSTRUCT ONMOTHER NATURE I PERMIT NO: 15040153 OWNER'S NAME: ERIC CHANG & MINH HWAI CHENG 1 3570 PACHECO BLVD APT 10 1 DATE ISSUED: 04/212015 1 OWNER'S PHONE: 4088966487 1 MARTINEZ, CA 94553 1 PHONE NO: (925) 212-7433 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 19 Lic. # 5LL a 16 � f Contractor l�� (/�/' OA 0 ( � 2 Date 1 hereby affirm that 1 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 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. APPLICANT CERTIFICATION I certify that 1 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. onally, the applicant understands and will comply with all non -point rce gulations per the no Municipal Code, Section 9.18. Signature Dat — 24 1 ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, wil I 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 construct the project (Sec.7044, Business & Professions Code). I 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 the 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, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL INSTALLATION OF ROOF MOUNTED SOLAR (30 MODULES)(7.8KW). Sq. Ft Floor Area: I Valuation: $26442 APN Number: 32630125.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: 1� 7Gz� Date: —� RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Mana strict I will maintain compliance with the Cuperli u pal C Ch er 9.12 and the Health & Safety Code, Sections 25 , 2 and 34. Owner or authorized agent: Date: 1 CONSTRUCTION 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 A ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature. Date CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a1cupertino.org AE PROJECT ADDRESS �O 7 /_ % �Z,, n �.. 1 APN N�� OWNER NAMEFr PHONE ( J��_ �/� ( — /�(G ) (J,\O(� EMAIL STREET ADDRESS !� 0 CITY, STATE, ZIPC�_f"IrJ FAX �1- ��JJtt�� CONTACT NAME�r� n,p �v� C��S E-MAIL)�S (h PHONE /7 q - Y00 _4 33/ l/^ t STREET ADDRESS J-� ((� J V ll❑•• 1 CITY, STATE, C V, (t/1 rFAX C-. -❑I El OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ON RAACTOR AGENT� ❑ E ARCHIT� CT_/ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �/� / r t/ I C /0V 9`- LICENSE NUMBER' 8 j ` Lf (j(�' LICENISETYPE 3 BUS LIC# ,l COMPANY NAME (/ // ✓ „p) I kF �� ("a(� E-MAIL I I . �- V t FAX STREET ADDRESS I 1 1 p 1 4 �J �•/ C ] l u J C ( f CITY, STATE, ZIP ^ / Vr I r J"ti ! V I ( ( I 1 - PHONE (42< ARCH)TECTIENGINEER NAME LICENSE NUMBER BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUCTURE ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ NO 4SOLARPANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS., NUMBER OF PANELSIUNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: `i { (� Ll 2 DESCRIPTTON OF WORK a RECEIVEDBY: I By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have 'ded is correct. I hav a e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ui n onstructio authosl representatives IF Cupertino to enter the atbyov -identified proper for inspection purposes. Signature of ApplicantlAgenC �/ Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS U w x ❑ STANDARD U ❑ LARGE w ❑ MAJOR nCt . C_ �/,_ PVApp_2011.doc revised 03116111 CITY OF CUPERTINO F-M-7- FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20766 Fargo Dr DATE: 04/21/2015 REVIEWED BY: SEan APN: BP#: j� `VALUATION: 1$26,442 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK Installation of roof mounted solar 30 modules 7.8k SCOPE P/runn. flan (7irc Elec. Plan C'11 —L-1 Orher ,Vech. Insp. 01her Plumb Insp Other Elec. Insp. Li tdrelt. Lisp. Fe!.Plran h. Imp. l'ec I:lec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl, PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 1 ,cr.v ,4a'ministrative Fee: 0 E) Work Without Permit? Yes No $0.00 Advanced PlanninL Fee: $0.00 Select a Non -Residential Building or Structure I E) 0 i Trowel Documentation Strong Motion Fee: IBSEISMICR $3.44 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5.44 $236.00 TOTAL FEE: $241.44 Revised: 04/01 /2015