13100073 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10250 BANDLEY AVE CONTRACTOR:SPRIG ELECTRIC PERMIT NO: 13100073
OWNER'S NAME: APPLE INC 1860 S IOTH ST DATE ISSUED: 12/02/2013
OWNER'S PHONE: 4089743516 SAN JOSE,CA 95112 PHONE NO:(408)298-3134
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r r
PLUMB
License Class /,% Lic.# `o 72—
MECH RESIDENTIAL r COMMERCIAL
Contractor rf L L GDate 4
I hereby affirm that I Ain licensed under the provisions of Cha er 9 JOB DESCRIPTION:
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect. INSTALL PV SYSTEM ON ROOFTOP,250 PANELS,86 KW
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
2. 1 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 Sq.Ft Floor Area: Valuation:$30000
permit is issued.
APPLICANT CERTIFICATION APN Number:32634069.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,t e applicant understands and will comply with 180 D F OM LAST CALLED INSPECTION.
all non-point so regulations per th Cupertino Municipal Code,Section 9.18.
12
Date Issued by: 4Date: Z I?
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is installed
the following two reasons: without first obtaining an inspection,I agree to remove all new materials for inspection.
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 Signature of Applicant: Date:
sale(Sec.7044,Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
2. 1,as owner of the property,am exclusively contracting with licensed contractors
to construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three declarations: I have read the hazardous materials requirements under Chapter 6.95 of the California
i. I have and will maintain a Certificate of Consent to self-insure for Worker's Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with
Compensation,as provided for by Section 3700 of the Labor Code,for the the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section
performance of the work for which this permit is issued. 25532(a)should I store or handle hazardous material. Additionally,should I use
2. I have and will maintain Worker's Compensation Insurance,as provided for by equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Section 3700 of the Labor Code,for the performance of the work for which this Air Quality Management District I will maintain compliance with the Cupertino
permit is issued. Municipal Code,Chapter 9.12 and the Health W\ o
,Sections 25505,25533,and
3. I certify that in the performance of the work for which this permit is issued,I shall 25534. /rnot employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: � Date: j Z�
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 CONSTRUCTION ENDING AGENCY
revoked. 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
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments, I understand my plans shall be used as public records.
costs,and expenses which may accrue against said City in consequence of the
;ranting of this permit.Additionally,the applicant understands and will comply with Licensed Professional
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATION
Ll COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(ftuaertino.ora
/--�;/CUPERTINO ( OW,7-j
PROJECT ADDRESS 2� r APN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS / 1 �I I � CITY, STATE,ZIP r )mo FAX
CONTACT NAMEPHONE
n him Y09 071 E Je ive.,
STREET ADDRESS CITY,STA ZIP FAX W
D r+' S S •v o
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT rJ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE T1T BUS.LIC#
4 �C, 2 L1q
COMPANY NAMErrC I v MCiVI M� FAX
STREET ADDRESS4 0 �• CITY,STA ,Z +1 , PHONE
✓ V08_40 9 -3/3y r 20?
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF C] SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: YJ Commercial URBAN INTERFACE AREA ❑ Yes Er No FLOOD ZONE ❑ Yes ((No
SOLAR PANELS 1 ❑ ELECTRIC VEHICLE CHARGING STATION 1 ❑ SOLAR WATER HEATING ❑ OTHER:
FoR SOLAR PANEL.. NUMBER OF PANELS/UNITS: 2 5"0 KILOWATTS(COMMERCIAL ONLY): Q/ TOTAL VALUATION: N/V1
DESCRIPTION OF WORK 1,V,5
`- LA_ f c+ L
B t(r
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p owner's behalf. I have read this
application and the information I have provided is correct. I have fead the Description of Work and verify it is accurate. agree to comply with all applicable local
ordinances and state laws rete' to bu'ding construction u rize representatives of Cupertino to enter the abov idden'fled roperty for inspection purposes.
Signature of Applicant/Agent: r Date:
SUPPLEMENTA INF RMATION REQUIRED OFFICE USE ONLY
_fT�ar OVER-THECOUNTER
�^ ❑ EXPRESS
❑ STANDARD
❑ LARGE
a
❑ MAJOR
PVApp_2011.doe revised 03/16/11
01
CITY
CITY OF CUPERTINO I>
FEE ESTIMATOR— BUILDING DIVISI N ,p
kADDRESS: 10250 Bandley Ave DATE: 12/03/2013 REVIEWED BY: Suew
N: BP#: 13100073 `VALUATION: $30,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial BuildingPENTAMATION
USE: PERMIT TYPE: SOLAR-COM
WORK Install PV System 250 panels, 86 kw
SCOPE
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-033 Elf. ?%1 13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.001 86 1 kW Alternative Energy System
Suppl. PC Fee: ) Reg. Q OT Q.Q hrs $0.00 $1,335.00 1PHOTOVCOM Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OTQ Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes ) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
i
Strong Motion Fee: 1BSEISMICO $6.30 Select an Administrative Item
Bldc Stds Commission Fee: 1BCBSC $2.00
SUBTOTALS: $8.30 $1,335.00 TOTAL FEE: $1,343.30
Revised: 10/01/2013