11010010I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 11054 LA PALOMA DR
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C- � � Li.. #
90 G I
Contractor rJrt J t ZC ICCWt0I - ate 2— 4—I
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, and expenses.which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant un rstands and will comply
with all non -point source re ions per the Cupe o Municipal Code, Section
9.18. .7 __— A
Date L 9
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I 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,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, 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. 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 mayaccrue 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: SUNW IZE PERMIT NO: 11010010
TECHNOLOGIES
I 1 I W SAINT JOHN ST DATE ISSUED: 02/03/2011
SAN JOSE, CA 95113 PHONE NO: (408) 510-5067
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
INSTALL SOLAR PANELS AT EXISTING ROOFTOP ON
SINGLE
FAM DWELLING, 3.44 KW
Sq. Ft Floor Area: I Valuation: $26000
APN Number: 35616048.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b / Date: � J — 61
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 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 Codg. Chapter 9.12 and
the Health & Safety Code, Sections 255*,'1953�d 255 y
Owner or authorized agent: Dater
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
WN
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11054 la paloma dr.
DATE: 01/03/2011
REVIEWED BY: bobs.
APN:
BP#:
'VALUATION: 1$26,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
TOT 4 L
FLOOR 41?1-1,4:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
install solar panels at existing sfd rooftop
SCOPE
Ifec%t. Plan k
1'lcnt L hecb
Alec.. Plary Ghack
Me(--h. Pcrmif Fell,
Plrtmh, Peonil Fce.
6lec. Pern- /
n711Lr Afech. Insp.
01her Plumb Insp.Li I
Other Elec. In.si"
IUcch. Insp, hec'
plum , Insp. !e"
Glec. Insp. Fee:
NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the DeDt for addn'1 info
FEE ITEMS (Tee Resolution 09-051 Eff. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$207.00
Photovoltaic System
ISOLARRES
Suppl. PC Fee: E) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction .Tens
Acoustical Fee: 0 Yes (F) No
$0.00
G
Work Without Permit? Q Yes E) No
$0.00
Planning Fee:
$0.00
E)
Travel Documentation
Strong Motion Fee: IBSEISMICR
$2.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$4.60
$207.00
TOTAL FEE:
$211.60
Revised: 12/07/2010