14110031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10555 MARY AVE CONTRACTOR:CUPERTINO ELECTRIC PERMIT NO: 14110031
INC
OWNER'S NAME: CITY OF CUPERTINO 1132 N 7TH ST DATE ISSUED: 12/08/2014
OWNER'S PHONE: 4087773232 SAN JOSE,CA 95112 PHONE NO:(408)991-1000
I* LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT A PARKING CANOPY(7231 SQ FT) WITH
License Classy�C-7 w11 iso 3 9 ROOF
Contractor
(.d ✓77/Lb /GG�YDatC /2 $ y MOUNTED SOLAR SYSTEM(340 MODULES) (103.7 KW).
I hereby affirm that 1 am licensed under the provisions of Chapter
(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:
l have and will maintain a certificate of consent to self-insure for Worker's
7C pensation,as provided for by Section 3700 of the Labor Code,for the
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$426000
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
r.PN Number:32606052.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA r MIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS,FS LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which ay ac a against said City in consequence of the 2 p �y
granting of this permit. Ad ti a he applicant understands and will comply ate: O
with all non-p int source re ul i r the Cupertino Municipal Code,Sectio
9.18.
( RE-ROOFS:
Signature Date `—�� All roofs shall be inspect prior to any roofing material being installed. If a roof is
e7� installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mu i ,1 Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505,233, 1 5534.
Section 3700 of the Labor Code,for the performance of the work for which thist — � LI
permit is issued.
Owner or authorized agen Date:
[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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,l must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
go 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building(d)cupertino.org
/ylloo3/
PROJECT ADDRESS 10555 Mary Ave. APN R 326 _p 12) -05A
OWNER NAME PHONE E- AIL
City of Cupertino �� AGEr/R�j yo 777•,3x3 at'x// ��pslP,-j�Q•d
STREET ADDRESS � F ✓� CgY, STATE,ZIP
CONTACT NAME PHONE �J E-MAIL
STREET ADDRESS CITY,STATE, ZIP PAX
OWNER El OWNER-GUILDER ❑ OUNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS LICk
Cupertino Electric Inc.
COMPANY NAME E-MAIL FAX
Cupertino Electric, Inc, kris_fabing@cei.com 408-279-2515
STREET ADDRESS CITY,STATE,ZIP PHONE
1132 N. Seventh Street San Jose, CA 95112 408-808-8000
ARCFIITECTIENGINEERNAME LICENSE NUMBER BUS.LIC k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD 0r DupleX ❑ Multi-Family PROJECT IN WILDLAND PROJECT M
STRUCTURE: ® Commercial URBAN INTERFACE AREA ❑ Yes M NO FLOOD ZONE ❑ Yes IZ NO
®SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTFIER.
FOR SOLAR PANELSr NUMBER OF PANELS/UMTS: KILOWATTS(COMMERCIAL ONLY): TOTAU/#T[0 ��
340 103.7 �•�d�p
DESCRIPTION OF WORK
Complete installation of a 103kW parking lot canopy mounted solar system. Project consists of
drilled concrete foundations, steel mounting structure, solar module mounting, and underground raceway into
existing electrical equipment.
RECEIVED BY•.
By my signature below,I certify to each of the foil wing'. 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 provi d correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu nstruction. ves of Cupertino to enter the above e ified property for inspection purposes.
Signature of ApplicantJAgent: Date'.
S PPLE NTAL INFORMATION REQUIRED OFFICE USE ONLY
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Pf'App_2011.doc revised 03/!6111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10555 Mary Ave DATE: 11/06/2014 REVIEWED BY: Sean
APN: BP#: 15 'VALUATION: 1$426,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION SOLAR-COMM
USE: PERMIT TYPE:
WORK I CONSTRUCT A PARKING CANOPY 7231 SQ FT WITH ROOF MOUNTED SOLAR SYSTEM 340
SCOPE MODULES) (103.7 KW).
Gtech. Plan(Yuck Plumb.Plun Chcc% Elec. P/on Check
Mech. Permit Fee: Plumb. Permit Fees: Elec.Permit Fee:
Outer 1-tech.Insp. ET_'L_
Other Plumb hzap. Li Other F,lec. lush.
Met* Insp. Fee: Plumb, Insp. Fee. Elee.Insp.Fee.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). Theseees are based on the prelimina information available and are on! an estimate. Contact the De t or addn'1 info,
FEE ITEMS Tee Resolution 11-053 L : 71'13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 104 kW Alternative Energy System
Suppl. PC Fee: Q Reg. Q OT Q,Q hrs $0.00 $1,628.00 IPHOTOVCOM Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.(F) Reg. Q OT O Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tctx:
Ac ntiniwrufive Fee: 0
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Foes: Building or Structure 0
Strong Motion Fee: IBSEISMICO $119.28 Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC $18.001 7
SUBTOTALS: $137.281$1,628.00 TOTAL FEE:T $1,765.28
Revised: 10/01/2014