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12030086CITY OF CUPERTINO BUILDING PERMIT BUILDING SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527 L�4 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C-10 Lic. H `75OIVV Contractor IgF'e 5uh,, Irr. Date 3 I'm tz I hereby affirm that I 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: l 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 1 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 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 regul ' s per the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following Avo reasons: 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 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 l 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. MECH r— RESIDENTIAL r— COMMERCIAL (~ JOB DESCRIPTION: 4AKW PHOTOVOLTAIC SOLAR MOUNTED FLUSH TO ROOF; 24 PANELS Sq. Ft Floor Area: I Valuation: $28000 APN Number: 34256018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D S FROM A2ST CALLED INSPECTION. Issued by: 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 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. �� Date: 3 fq Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional CITY OF CUPERTINO BUILDING BUILDING ADDRESS: 23637 BLACK OAK WAY OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class G — 10 Lic. 4 -77 b f 9'14 Contractor QZ_ 'SOyi4Q Date y—.2 iZ I hereby affirm that I 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, -poisource ich may accrue against said City in consequence of the granting Additionally, the applicant understands and will comply with all nreg ati s per the Cupertino Municipal Code, Section 9.18. Signature Date y^ 2 —/ i ❑ OWNER -BUILDER DECLARATION l hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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, 1 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. CONTRACTOR: REC SOLAR, INC. 775 FIERO LN STE 200 SAN LUIS OBISPO, CA 9340I PERMIT NO: 12030086 DATE ISSUED:03/19/2012 PHONE NO: (888)657-6527 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r— MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: 4.4KW PHOTOVOLTAIC SOLAR MOUNTED FLUSH TO ROOF; 24 PANELS 4/2/2012-REV41- RELOCATE THREE(3)MODULES AND ADD ONE(I) ADDITIONAL MODULE-REV/f 1 ISS'D 4/2/2012 Sq. Ft Floor Area: I Valuation: $28000 APN Number: 34256018.00 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: 'S / � : 5/'�'/O` 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 l store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own "I �-- f Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO WN FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 23637 Black Oak Way DATE: 04/02/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK Revision #1: Relocate 3 modules and add 1 additional module. SCOPE 14"(41, Nari t i (-A 11Ph aaif, Plofl ChecA Elegy-. flan Check iifcch. l'cowl Pce.' itP7lT b %`c^c: Etic. peniali' l'd.'c': 0/l7f'i" Li U/trc'/El((., r,1w,h. I'f'" rk,(_ lY7;p /" C. NOTE: This estimate does not inchede fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etr-). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $0.00 Alternative Energy System 1 Photovoltaic System Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 oction !(Ati l is(rutivE Fee: 1 0 0 Work Without Permit? © Yes 0 No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure g 0 0 � TrTravel1)ntrrrjrrr>ntatior7 1•'ecs: Strong; Motion Fee: $0.00 F-6-51 hrs $41.00 Admin./Clerical Fee IADAEN Bldg Stds Commission Fee: $0.001 SUBTOTALS: $0.001 $41.00 TOTAL FEE: F $41.00 Revised: 1 /19/2012 W��,,�--�� CITY OF CUPERTINO -W FEE ESTIMATOR - BUILDING DIVISION iaADDRESS: 23637 black oak way DATE: 03/19/2012 REVIEWED BY: larys APN: p, o BP#: "VALUATION: 1$28,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES I PERMIT TYPE: WORK 14.4 kw photo voltaic solar mounted flush to roof. 24 panels SCOPE NOTE: This estimate does not include fees due to other Departments (4e. Planning, Public Works, Fire, Sanitary Sewer District, School District_ etc 1_ These fees are hated nn the nrelin=nnry infarmatinn availahly and ore nnly an estunate_ Cnnlart the Dent for addn'l Info_ FEE ITEMS (Fee Resolution 11-053 E . 7,1/1 J� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $214.00 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: E) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 E) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Pee: $0.00 Select a Non -Residential Building or Structure E) C StroDg Motion. Tee: 1BSEISMICR $2.80 Select an Administrative Item Bld_&Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $4.80 $214.00 TOTAL FEE: $218.80 Revised: 1 /19/2012