04100060 CITY OF CUPERTINO " m ""
BUILDING
DIVISION PER �CONTRACTnRINF,,qq��ORMAN
BUILDING ADDRESS: PERMIT NO.04100060
10';14 ANhI ARROP AV PERMfP LSSUE DATE
OWNER'S NAME:
YAO SUN
SANITARY ONTROL NO.
401—NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
uaZ LICENSED CONTRACTOR'S DECLARATION
0 o Job Description
w 1 hereby affirm Nm 1 am licensed um
nder provisions of Chapter 9(comencing
�ZW with Section 70M)of Division 3 of the Basins and Professions Codc,and my hot.c is
4,o- 1.17,in fu o nd cffett +
,q� License �/ Lic.'x 41 v1 PHOTOVOLTAIC SYSTEM (ROOF MOUNTED)
zF,i to nn Cimoctor CONTRACTOR: COBALT POWER SYSTEMS, INC.
g� ARCHrtECTS E e6WTION
l undersand my plans shall he used as public records
D,U
is 0t Licensed Professional
S OWNER-BUILDER DECLARATION
^g 1 Worhy infirm that 1 an eaempt from But Contractors License Law for the
10 following reason.(Section 703 1.5,Business and Professions Cod,:Any city ser county
K m 14 which requires a Permit In ennswct,almf,improve.demolish,no repair any someone
prior to its issuance.al so requires the applicant for such permit m file aligned satement
—E< Nat he is licensed Pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valu�t0962
is--� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he u eaempt therefrom and the bazar for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation, 32655020 . 00
will do the work.and the structure is not intended or offered for sale(Sm.7044,Business Required Inspections
and Profession Code:The Commclon,License law docs not apply lf an owner iof
s q p
property who buildsn,Co a improves thereon',and who Law does
himalf an
his
avnemployces,provided that such improvements uc not intended mortared forsele.If.
however,the building or improvement is sold within one you of compladon,the owner
builder will ham the burden of proving that he did Out build or improve for purpose of / a
sale.).
❑I.as,me,of she preplan,am eschadmil,contracting wish licensed connotations to l.Jl/�
construct the project(Sec.7040,Business and Professions Coda:)The Conlnctor's Li.
cense law dors nut apply to an owner of property who builds or improves thereon,and. ,/V
who contracts for such projects with a conlnemr(s)licensed pursuant to the Control
License Law.
❑1 am eaempt under Sac. .B&P C for this rnson
Owner Dale
WORKER'S COMPENSATION DECLARATION
41 1 hereby affirm under penalty of perjury one of the following declamations:
❑1 ham and will maintain a Certificate of Consent to ulf-insme for Worker's Compan-
salion,as provided for by Section 3700 of the Labor Code,for the Permorromes of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insu amce,u required by Section
J700 of the Labor Code,for Ne performance of the work for which this permit is issued.
My Worker's Cynm�PeJma�uon lnsmmna ca brand Policy numbcrare.
1-r<c�y r'1 ?�' Bowen:/'7r,PZ71-7
CERTIFICATE XEMMU FROM WORKERS'
COMPENSATION INSURANCE t
(This section need not he completed if the permit is for one hundred dollars(SIM)
cr less,)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any mannerso az to become subjrcuo the WorkeK Comp reation
Laws of California.Date
r Applicant
'NOTICE TO APPLICANT:If,after making this Ccniftue of Eacmption,you should
become subject to the Worker's Compcnsaion provisions of the Labor Codc,you must
.J forthwith comply with such previsions or this permit shall be doomed avoked.
7-0 NCONSTRUCTION LENDING AGENCY
[+ I hereby affirm that them is a construction lending agency rot to pNrtormance of
a > the work fur which this permit is issued(Sao.3097,Civ.C.)
WWLanders Name
a Z Lender's Address
V O 1 ccoJfy that 1 have mad this application and sate that the above information is
Iy F toren.1 agree to comply with all city and county ordinances and sme laws relating to
0(J building construction.and hereby a domiae repmenutivev of this city to cmcr upon dm
W shove-intromed pfopcny for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Imbilitiu,judgmcnls,eosa and expenses which may in any way aceoc against said City
V z APPhis permit.
LICANTeUNDERSTANDS or the granting of tAND WILL C MPLY WITH ALL NON-POINT Issued by: Date
SOAR EGULAT ONS. a
i c Ori i O Re-roofs
tare ofApdicmVCmOr Date
HAZA OUS M/TERIALSDISCLOSURE Type of Roof
Will Ne applicant or future building occupant store or handle havardous material
az defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 3ss3z(a)?
0Ycs No
��, ��/ All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant mr future building Occupant rose equipment er devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hicommour air contaminants at defined by the Hay Area Air Quality Management all new materials for inspection.
1 Distdct'm?
❑Yes Nu
1 have read the humorous materials requirements under Chapter 6.95 of the Cali foo-
ma Health&SafetyCodc,Section 25505.25533 sou1355J4.1 undersand that if the building
docs not sum m y have a tenant that it is on,osmotic hility to nod I the msupam of Ne
be twmm sl be mm prier toissam< fa Ccmficaw of Occupancy. Signature of Applicant Date
���� t. All roof coverings to be Class"B" or better
IScr or authorirsd agcm , / Oa
V,
z APPROVE6 c
IN 00
ACMANCE WITH THE CITY, y
cvpt IN C S A .OR
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SIGNEfr MUSS g CITY OF CUEEPTItNO
This sec SII P,•„ ILMN � a
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la ` ke any changes or, altera on9
a sna without written permission NO a r
the bu dhr'jDept•. cwy of Cupertino. m
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SHARP RESIDENTIAL SYSTEM MODULE
167 WATT
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POWERFUL. ATTRACTIVE. RE h It€'° ' XPffL4 ;0
E
OCT 112004
MULTI-CRYSTAL SILICON PHOTO0TAICQODULtR1f1 v
WITH 167W MAXIMUM POWE"GUILDING DEPAaIM
Designed specifically for peak roofs,Sharp's ND-167U1 photovoltaic
modules offer industry-leading performance and aesthetics.These residential
modules give the clean,attractive appearance of a high-tech skylight while
the black anodized aluminum frames and trim strips blend beautifully with i
the home's exterior.In addition,an"L"hook design located along theframe's
perimeter ensures easy integration with the residential system mounting +rit
. ,,tr , ,
• hardware.Perfected by Sharp's nearly 45 years of researc men� ,iiE:q. �"Ri� ;4 ,�
lir s . } s
these modules allow for maximum usable power.) nI�[ P.Ic9gg
using 48 square multi-crystal
provides a uniform blue color and increases light abso U ion in all types silicon scil�r cells�;iil�12.6%
of weather conditions.Sharp's ND-167U1 modules are a breakthrough ini? uWconveriia"nefficiency
technology and aesthetics. long frame plermeter for easyimegration with residential.
and,"L"hook ilesign located
1
system mounting hardware
EVA I�minate,land a weather
proof film yield long-life
i. modules whili enhancing
The laminated glass module is glazed Sharp's residential modules with black frames omma 16 DC output is an
Into a high torsion black anodized and trim strips are ideal for peak roofs,and
ea match for the Sharp
aluminum frame. allow for the seamless integration of the
system into the home's design. ...multi-string in,�erter
Manufactured in ISO 9001
ND-167UI RESIDENTIAL SYSTEM MODULE
167 WATT
mom
Cell Multi-crystal silicon 7DImensions(A x B x C below) 52.28 x 39.53 x 1.81•/1328 x 1004 xNo.of Cells and Connections 48 in series 35.2]Ibs/16.okg
Open Clrcult Voltage(Voc) 29.0V Configuration 2 pcs per carton
Maximum Power Voltage(Vpm) 23sV arton 563x42.52 x 5.12'/1430 x 1080 x Baron
Short Circult Current(Isc) T lA Maximum Power Cur `4
Maximum Power(Pi 1aT 1ER�1�_y/1/�
Minimum Power(Pm)' 150.3W pn
Encapsulated Solar Cell Efficiency(qc) 14.39x t)U
Module Efficiency(qm) 12.60%
PTC Rating(W)** 6 OF ORR atng Temperature -40 to 194'F/-40 to+90'C
Maximum System Voltage x 6o vpc tora)e perature .40 to 194'F/-4o to+90'C
— uEm 1 �
Series Fuse Rating Dielectric Isolation Voltage 2200 VDC max.
Type of Output Terminal Lead Wire with MC Connector
�Ilil f
� I
A
Cell Temperature: 25'C ne
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(t)
V
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Voltage[VI -
-cur.em 9s.voXage r
L po ,a.v9hage
Power vs.Voltage Characteristics A D C D E F B
52.VrA321mm 3933']]O ]el'p6mm I0.]'//J9mm IS]5'NOMe JLIYMImm ]5.16'Pollmm
Specifications are sub)en to change without notice.
•(STC)Standard Test Condidons:25C 1 kW/m',AM 15
••(PfQ pacific Test Condl[Ions:20C,1 kW/m',AM 1.5,1 nJs wind speed
In the absence of confirmatlon by product manuals,Sharp takes no responsibility for any defects that may occur In equipment using any Sharp devices:
Contact Sharp to obtain the latest product manuals before using any Sharp device.
SHARP. I be sharp'
164 Sharp Electronics Corporation•5901 Bolsa Avenue,Huntington Beach,CA 92647
Tell-800-SOLAR-06•E-mail:sharpsolar@sharpusa.com•wwwsharpusa.corn/solar
®2003 Sharp Electronics Corporation SSD-03-009 Printed in the USA
SunnyBoy 25000 M-:i F
*The leading grid-tied photovoltaic inverters if1; rico
UL 1741 Listed
'or grid
interactive
inverters
comprehensive AS
warranty
Rugged NEMA
4X stainless steel
outdoor
enclosure
standard
suninay ,
Exceptional Boy
reliabilityand
�—o
• capture ratio
energy ^-
tc�.
asy
hree-
• .
optionsmounting system
Comprehensive
communications
and data
collection
.. sbc. "opwra&pky
Modular
String inverter The SMA Sunny Boy inverter, the most popular grid-tied photovoltaic inverter in Europe, is
design is now UL 1741 Listed and available in North America. Sunny Boy's extensive track record in
expandable
virtuall •any system size isome of the world's most demanding markets has made it the favorite among RV professionals
everywhere. Over 200,000 Sunny Boy inver� ave�e:en innsttaalle�\wo�Idwide H�v"ng
achieved the highest reliability of an Pv i0 sw y g �� P
9 N Y un r amW immediate acceptance
in the US and Canadian markets. Superior design, rock-sdiAGyt1n hgineering, and
® exceptional real-world efficiency have made Sunn @Qy,the a ,chp . fo- m n solar
designers: These professionals know that Sunny 6�ts a gri ied i(, ,[�jJthbt��he an
LISTED recommend without reservation and install wi�i+a nf�r�'e.
UTI M
w.
SUNNY BOY 25000
° INVERTER
` a a OR ND NEU L
BREAKER
• SIZE
U z m 2P 15 AmP
AC
DC DISCONNECT
w_ DISCONNECT SWRCH
SWITCH
w
ARRAY AC
(�� !J DISTRIBUTION
Specifications for Sunny,B!ibyr200� I �J�}�� Copl J
Inverter Technology Real sine-wwe,C'L't 9h umry M C1 4Y1-.^J� yl A � Nn
AC Input Vol" 213-262(240 V AC) a 183-229 & ))1 2004 19}+'JJs NJ
AC Input Frequency 59.3�O.S l60 Hzl,SO Hz a so availab C
DC
ut Voltage
Peak PoowerTmdang Voltage 234-550� By n�� �JIN YO s unsurpassed reliability and efficiency is the
PVSlWVo� E�J�o.�7l V EPAC2Ilvip f t
resu t o SMA's manufacturing philosophy that combines
Minimum DC Input Voltage 207-256 V dependent on available litre voltage
Maximum Array Input Power IDC @ SKI 3000W(240 ACI,26WW 1208 V AC) , simple design with robust execution. SMA's state-of--the-
-r-.
Maximum AC Power output 25o6 w 1240 v Aq,2200 W 1208 V ACI art maximum power point tracking performance results
Correnracto Less than 4%
Power Facia unit' in greater real-world energy capture than any other
�'
Peak Inverter Efficiency 94.1%, grid-tied PV inverter. Sunny Boy's safety and reliability
Maxim° Convection cooling 1"°
Maximum AC Cutout Current12..00 A record is also exceptional due, in part, to the inverter's
� A
Maximum DC Input Current 13A redundant grid monitoring and built-in ground.fault
DC Voltage Ripple less than 5% detection and interruption protection. The inverter's
Powa Consumption 0 W nighttime,<0.25 W standby
Ambient Temperature Reding 45°c IGBT power stage generates o nearly perfect sine wave
Enclosure NDM 4x stainless steel with the lowest harmonic distortion in the industry and
Sae 17.1 W x 11.6 H x 8.4 D inches
(434 W x 295 H x 214 D mm) meets ultra-strict FCC EMC standards. SMA's unique
Weight / 71 lbs(32 kill String Inverter technology makes future system expon-
compliance United States:
UL 1741,E210376,UL 1998,IEEE 519,IEEE 929 Sion simple. SMA advanced communication options are
ANSI C62.41 Cl &C3,FCC part 15 A89 available to satisLL'almost an application.
International:
7 Y PP
DIN EN50082 Part 1,61000-32,50081,50014,600055 Part 2,
55011 Group 1 Class B,50178,60146 Part 1-1 *Optional external fan(Sunny Breezel available
ALL SPECS MAY CHANGE WITHOUT NOTICE
SMA America,Inc., 12438-C Loma Rim Drive,Grass Valley,CA 95945
DISTRIBUTED BY Phone 530-273-4895•Fax 530-274-7271
' v .SMA-AMERICA.com-email: info@SMA-AMERICA.com
Solar Today...
Energy Tomorrow
e ,
R.9/25/03
' POWER -
5 - - POWER RAIL PRICES
ir
t .--QUALITY HARDWARE FOR THE PV INDUSTRY
• ' POWER RAIL MODULE MOUNTING SYSTEMS
The POWER RAIL PV Module Mounting System Is a top-clamping module mount designed for
parallel-to-roof arrays. The POWER RAIL extrusion is 6061-T6 structural aluminum. The Mid-
Clamps and End-Clam s are T e 304 stainless steel. All hardware is stainless steel.
Retail Pricing: NUMBER OF MODULES
MODULE 2 3 4 5 6 7 8
ASE ASE50 $120 $150 $185 $220 $260 $275 $ 5
AMERICAS ASE300 $230 $285 $330 $400
ASTRO- AP65/75 $120 $150 $185 $P2 , 3 5
P_ AP100/110/120 $135 $170 $220 P $365
BP SOLAR BP75/85 $120 $150 . $185 $220-- $260 $275 $305
BP150/160 $150 $185 $260 $290 $325 $380 $420
EVER- EC47/51/55 $135 $170 $220 $260 $290 $320 $365
GREEN EC94/102/110 $135 $170 $220 $260 $290 $320 $365
KYOCERA KC120 $135 $170 $220 $260 $290 $320 $365
KC158 $180 $220 $310 $350 $395 $450
WATT
PHOTO- pW75 $120 $155 $190 $225 $270 $285 $315
PW100 $135 $170 $220 $260 $290 $320 $365
5W 125 $150 $185 $260 $290 $325 $380 $420
PW165 $190 $231 $325 $365 - $41.5- $47.0
SHARP SH80 $120 $150 �$" 85 !, $2.2.0,1 t$2fi 1 $275' $305
SH123 $135 $1701 ¢$ 0�J $260' OT _$320i $365
SH165/185 $150 $185 60 ;$290"" $325 $380 $420
SHELL SP70/75 $120 $150 $185 $. 0 $275 $305
SM1001110 $135 $170 $220 60 $290 „ $3 $365
SP130/140/150 $150 $185 45 1W 8, $420
SOLAREx SX75/80/85 $120 $150 $'1'8' 0 $ 60, $2751'• $305
SX110/120 $150 $18526L11h 217 $ 20 ' $3 5' $390
SUNWIZE SW85/90/95 $130 $160 $210 $250 $275 $305 $340
SWI 10/115 $135 $170 $220 $260 $290 $320 $365
UNI-SOLAR US64 $150 85$1 $245 $275 $320 $355
1390
Prices shown include the appropriate number of end-and mid-clamps and our Standard Mounting Feet. POWER
RAILS can also be used with our POWER POST roof stand-offs(add 20% to the above prices). POWER POSTS are
1-3/8"diameter, are all-aluminum and have a 3/8"-16 threaded hole in the top of the post. See our POWER RAIL
MOUNTING OPTIONS sheet for other attachment possibilities.
Energy Outfitters Ltd
543 Northeast"E"Street— Grants Pass;OR 97526
ph: 800 GO SOLAR (800-467-6527) fax: 888-597.5357 www.energyouffitters.com
POWER = POWER RAIL
QUALITY HARDWARE FOR THE PV INDUSTRY MOUNTING OPTIONS
STANDARD FEET POWER POST TALL FEET
• .188'' aluminum • all-aluminum .188" aluminum
• 1.375" dia. 6" tall
• .25"x1.5"x4" base
OCT 11 20D
These are the standard Use with foof Ishin � �U�s� en more clearance is
co�i
mounting feet supplied with Attach toEbQttom�f� dMPA �aldl�etween roof and
POWER RAILS. The hold POWER d�IL or use ower mo u es. Vertical slot helps to
the bottom of the module 3.5" Post Bracket. Other heights level and align arrays.
above the roof. available. Other heights available.
• Retail Price: $8.50ea. Retail Price: $22.00ea. Retail Price: $12.00ea.
POWER POST BRACKET EASY FEET Z-FEE
• .125" aluminum • .125" aluminum " 5' "fyu"
0 Ute'✓
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Good when you can't hit roof Use directly with POWER
Use on top of Power Post to rafters. Supplied with butyl. RAIL or for runs of strut-
attach to side slot in POWER mastic on bottom and Roof channel with POWER RAIL on
RAIL. Vertical slot in bracket Grip screws. top. Supplied with butyl mastic
helps to level and align arrays. on bottom and ROOF Grip
screws.
Retail Price: $6.50ea. Retail Price: $20.00ea. Retail Price: $18.00ea.
• Represented By: Energy Outfitters Ltd-543 Northeast "E"Street Grants Pass, Oregon 97526
800 GO SOLAR (800-467-6527) Fax 888-597-5357-www.energyoutfitters.com
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•
3130DB0301
05/2003
r
Data Bulletin Lexington, KY USA
Direct Current and Photovoltaic Systems
Applying Heavy Duty Safety Switches (Fused and Not Fused) on DC and
Photovoltaic Systems
Class 3130
Retain for future use.
DC SYSTEMS All heavy duty safety switches with DC ratios(3-pole fusible and not
fusible)are Underwriters Laboratories®(ULn Listed for use on DC
applications when wired as shown in Figure 1 (A and B). Additionally:
• Heavy duty safety switches are rated for 250 Vdc or 600 Vdc maximum
open circuit voltage."'R
• Not fusible safety switches may carry 100�percent' f. e-namepi to
current rating. tf LL t �J y y �' ' "L_✓
• Fusible safety switches may carry 80 percent of nameplate current
rating(continuous use). OCT 112004
• Heavy duty switches are do horsepower rated as indcated on the safety
switch wiring diagram. CITY OF C K--RfINO
• Heavy duty switches have a 10,000 amperage do shod-circuit rating
` unless otherwise staled on`ihe switcliwirLgydiajRam�l�l��)JI
u vv+w�
Figure 1: Fused and Not Fusible Wiring Diagram
(Not Fused Shown)-
LINE e00 vdc q LINEA 60OVdc
• ---� ---� I I +
LLOADVW
A
Y
•^ O 2003 Schneider Electric All Rights Reserved
D EK2UAFqE n
Direct Current and Photovoltaic Systems 3130D80301
Data Bulletin
06h003
Y
V PHOTOVOLTAIC SYSTEMS Square D has obtained a limited UL Listing(File E2875,Vol.1)for 30 A,600 V,
heavy duty safety switches when used on photovoltaic systems and wired .
as shown in Figure 2.The National Electrical Code®(NEC®)does not allow
the negative conductor to be switched when disconnecting photovoltaic
systems(NEC Article 690).
Figure 2: Negative Grounded Feed per NEC Article 690
LINE Photovoltaic Array 600 Vdc Max Open circuit Voltage
I I I
--- ---- 30 A,Goo
Fused or Not
Fused
+ + + Disconnect
' (Not Nsed shown)
LOAD
(1)2500 Watt Inverter per Pop
Inc Current-Limiting,No Backleed With
�`�}N�'ootyt Fused Disoonnect)
Limitations Heavy duty safety sw s A ?f'��ff"� (fu 1 le)may be used
on photovoltaic system's 't aUYtt1 n ed. star to Figure 1 B
and Figure 2.The following limitations apply when wired as shown in
Figure 2:
• The maximum current from the photovoltaic array or photovoltaic string
shall not exceed 18 amperes direct current(dc)per pole.The rated(at
Standard Test Conditions)short-circuit current per pole for the photovoltaic
array or string shall not exceed 11.5 amperes(18 Ar1.56).
• The maximum do operating current drawn by the-inverterFshall not
exceed 14 amperes per pole:One'invertei in y be�oonnected to each
pole of the switch. ,f�,a ° \P
• H a not tumble disconni" used, keit ( \t not capable of
backfeeding currents into a short circuit or fault i th otovoltaic array
or string. QCT 1�
Refer.to Table 1 below for the 30 A It duty-safety switCFPwiie'lt'a�g .
Table 1: Safety Switch WireRange T
Wire Range ofa
-Oul ' ......
Ampere Rating per Phase eWire
Range of Lug
AWCLAWG/kcmil(1)012-_ 12-2(Aq30A (1)014.6(cu) 014-2(0u)(z)014-10(cu)so14_10(cu)solid(z)014-10(cu)atr14 10(cu)so-anaae
. 1 MSQ0 on NEC Table 312.6(8)
s
Square D Company Electrical equipment should be installed,operated,serviced,and maintained only by
• Loot Mercer Road . qualified personnel.No responsibility is assumed b y
- Lexington,KY 40511 USA � Y Schneider Electric for an
L-BBB-square0(L-eee•77e-2733) consequences arising out of the use of this material.
•
www.SquareD.cont
2 ❑D SGuARe D 0 2003 Schneider Electric All Rights Reserved
CITY OF CUPERTINOO
CITY OF PERMIT APPLICATION FORM O `f �szsa o
CUPEkTINO
APN# 3 Z S C o2-0 Date: oe
Building Address: Mailing Address (if different from building address):
/,9-),/y j l' GGr / 's'O S
Owner's Name: Phone#:
trio S 2/2
Contractor: License#:
Ga cPI Pl S r ��yar lr�_
Contact: - l Phone: 6fo-iyy1g. yy Cupertino Business License#:
/ 'rP n Fax:�fo� f'
Building Permit fo:
Bl Ele6i'❑ Plumb ❑ Mech ❑
Job Description:
Residential 2 c Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group4*ft
Type of Construction: Please check thisect is a
second-sto add
Project Size: Standard ❑ Laze ❑ Ma-or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax =Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
• Zj77 z 73
1 of 3 /�. �p / 21,
7
�(,ap-
OCITY OF CUPERTINOD
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMIVIE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTWE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
LIV BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace > I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREN2 RAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
i p, WITY OF CUPERTIN(*
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Ligbting Fix ELECTRICAL `
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
j EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
•
•
3 of 3
CITY OF COPERTINO `,
BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION ',
BUILDING ADDRESS: PERMIT NO04100060 4100060
10114 ANN ARROR AV
OWNER'S NAME: PERM17 L'SUEDATE
YAO SUN
Eo SANITARY ONTROL N0.
A0.CHIlECOENGINEER: -• -
BUILDING PERMIT INFO
• BLDG ELECT PLUMB MECH
t� 0
_O
pp LICENSED CONTRACTOR'S DECLARATION Job Description
Y FF I hereby affirm them l am Remand mother provisions of Chapter 9(commencing P
-Zwith Section 7000)of Division 3 prise Business and Professions Cade.and my license is .--
��� inrm fpr nderc t.� �O PHOTOVOLTAIC SYSTEM (ROOFF�
z Lkemc Lk.
;-o k cant..9' CONTRACTOR: COBALT POWER Y
ITECI'SD ON
4a y I understand my plana shall Ile used m pmM C reCurtis
;off 5eenaed Pmfcmanal OCT
g 2004
3 OWNER-BUILDER DECLARATION
aF 1 hereby M.that I am exempt from Ne Condnm's Liceeu Law for the
00 following reason.(Second 7031.5,Business and Pramu m Code:My city or county
K 3� which requires a permit m consumer,eller,improve,thmoliah,or repair any slmcwm
''lion prior a its houenCe,also menoca Neapplicanl forsuch permitm file a signCesulement
S
< that he is licensed pursuant to thepdnvisionsoftheContracturiLiaenscLaw(Chapmr9 Sq.Ft. Floor Area 962
sec (commencing with Section 7000)ofDivision J of the Business and Professions Code)or
.- that im is exempt therefrom and the basis for lie alleged exemption.Any violation of
Section 7031.5 by arty applicant for it permit subjects the,applicant to a civil pansldy of APN Number Occupancy Type
not mare Nan Ow hundred dolls.(S500k P Y YP
❑l.umnuofBtepropmy,mmyemplp wiltwagemweirmleCmeMmtion, 32655020 . 00
will do the work and the swctme is not intended oro@red fonale(Sec.7066,Business
and Professions m
Code:The Comunes Liceruu Law Me re
Ml apply In an owner of Required Inspections .
property who builds orimprove thereon,andwho doesuch work himulforthrough his
Own employers,provided dhatsuch improvements arc notin¢Med at offered for We.If.
however,due building or improvement is sold within one year of completion.the owner-
builder will have the Wrden of proving and he did not build or improve fm purpose of
W'.).
❑1,as Owner of dhc property,am exclusively contracting with licensed contractors to
construct the project(Sec.7066.Business and Profesiom Code:)The Container's V
Genu Law does not apply to an Owner or propeny who builds or improve(hereon,and,
who comment for such projects with a conuacmr(s)licemed pursuant as the Counselors
License Law.
❑I am exempt under Sec. ,B&P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hcteby of eon under penalty of perjury arc of the,following declarations:
have and will maintain aCerifieau of Consent to self-insure fm WorkmesCOmpcn-
ntion,asprovided for non Section 3700 of the Mbar Codc,for Clue performanceOf One
wok for which this permit is issued.
1 nava and will maintain Workers Compensation Insurance.u required by Section
1700 of the Labor Code,for the pufmrnana or the work for which this permit is issued.
My Worker's Cnmpensalion Insurance ca 'er an'd Policy number ate:
C TiFI CO l7 FRO-M WORKERS'
COMPENSATION INSURANCE
mum section recd nod bccompM¢d if the permit is foronc thoulmA dollars(S10I)
or less.)
I certify the in the performance of the work for which this permit is issued.l shall not
employs,person in any mannerso az o bootee subject to 0neWorkets'Campcnndor -
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcom of Exemption,you should
become subject in thc Workor s Compemaupn provisions of the Labor COM,you most
.Jz forthwith comply with such provisions or this perm it shall be deemed ucvekcd.
Z OCONSTRUCTION LENDING AGENCY
[-ir IherebyaRrm tot Nen iaa mmtrucuan lending agency for the ,it..of
a the work for which this permit is issued(Sec.3097,Civ.C.)
fi] Lenin's Name
a
Z Leader.Md.
U Q I Certify Nat 1 have read us,application and state Nat the above information is
fon FCorrect.l agree to comply with all city and county ordinances and suk laws palating e
C)U building Construction,and hereby authorise repueuntadives of Nis city to enter open the .
C snow-mcmidgm property for inspection purposes .
i ern Iiebilidi(We).9.up sam.u,emu indenifyianWhich d taemeyiacal anyWay the
city
rCursUC lnsnct against
Gilt
[)z in coramumace of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL C MPLY WITH ALL NON-POINT Issued by: Date
SOUR EGULATIONS.
O 0 Re-roofs
me of Applicane Cont orDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fume building nccupanl aiorc or handle hevarduus m ndrial
as defined by the Cupenium Municipal Code.Calls,9.13,and the Health and Safety
code,neon zss3z(a)7 ��, ��/ All roofs shall be inspected prior to any roofing material being installed.
Te �rHu
Will Ire a Ikant airr(dome Wilding excu ant.equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
pp e p aAir Qug
it mar dnus air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
JISIflL17 -
Yes Nu
1 have read the humorous malcrialstcyuimmenu under Chaplcrti.95 of Nc Califor,
nil Health&Safmy Cock.some.35505.25533 and25536.1 unMtwvtl thaifNe building
docs dot currently have a amnl•Nat it is my responsibility,to notify the occupant of the
en which xMCI prior tonauan faCerdBcatepraapancy. Signature of Applicant Date
cr 6r authorised of 1 Dom All roof coverings to be Class "B"or better