04080155 CITY OF CUPERTINOY�a 7n " ra9 w.
BUILDING DIVISION PRR� CONTRACTOR INFORM.•ON,
ate. x '.. tx. ..,*9a.�Le➢^ a, ."sid�a - C.
BUILDING ADDRESS: MC SOLAR ENGINEERING PERMIT No.04080155
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY O OL NO.
ARCHITECT/ENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o ch, LICENSED CONTRACT'OR'S DECLARATION
a w C I hereby effort that 1 am licenud under provisions of Chapter 9(commencing IO a rijj)��IInO,a p �a I
eibw With Section 7000)or Division 3 of Ne,Business and Professions Code.and my license is 11 //h
n« in full once and effort.
111111116666j1�J1N/^�''a
-qZ L;ccn¢ IaziL;c.a -1 fo S SOLAR ELECTRICITY ON ROOF
-o Oaminrt Conu.nor (� r�� �/s Iy
I� T
ARCHITECT'S
DECLARA'10" �fl ll� <O LOat
e< I undersand my plans shall W used az public rccmds
�nU
Licensed Publications]
OWNER-BUILDER DECLARATION �p p I L tii� I'1;a B
a'<f 1 naso affirm Nat 1. exempt from Nc Camrns CoLicense: Law for the IBIS J/IpI [ppJf®J Ilgy®VB
zoo followingreason.a.(Section]I1JL5,Business and improve
de Professions Coate:Any city ocounty
%m which its
a issuance,also la cxne reathe alter.i t for su demolish,nr repair any swctunt
m�'^ that hepoor imenseprsamm to the Nprovisions
visio sof the Contrach rmiuoiccnxo Law(Chapter
or
that heiscingwitpSectiouolhcofDivision3NCCommcmrindPnsssio(Chop¢r9 Sq. Ft. Floor Area Valuation
rot- (cat he
(commencingwith heeirom ndm basis for
thethe
egeBusiness mtl Professions Code)of
Sec he is exempt any applicant
p li and or bath for the alleged applicant
to Any violation of
not on than by any reddmsforapcmirsubjectsNcapplicantmacivilpenaltyof 30,Ftliiftigklel00 Occupancy Type
not mom than five hundred dollvs(5380).
L]I,its Owner of the property,or my employees with wages ar Over sole compensation,
will do the work,and the smcture is not intended or affemtl for sale(Sec.7044,Businow
and Professions Cade:The Commeaors License Law docs WE apply to an owner of Required Inspections
property who buildsor improves themonand whadoessuch work himself or through his
own employees,provided that such improvements are not intended oroRcmd for sale,If,
however.the building or improvement is said within ane year of completion,the Owner
•Wilder will have the burden of proving that he did not Wild or improve for purpose of
sales.).
❑1,as owner of the property,am caclusively convecting with licensed contractors to
consumer the pmjea Sac.7044.Business and Professions Code:)The Convactols Li-
cense Law does not apply to an owner of property who Wilds or improves Neaten,ad
who contracts for such projects with a contractor(s)licensed pursuant to the Conmaur's
License Law.
[J)am exempt under Sec. B k P C for his reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby if itm under penalty of perjury one of the following declarations:
I ban and will maintain a Cerdfcam of Consent to self-insem for Worker's Conal
union.as provided for by Section 3700 of the lahor Code,for the performance of the
work for which Nis permit is issued.
Ww and will maintain Workers Compensation Insurance,as required by Section
3 of the Labor Code,for the performance of the work for which Nis permit is issued.
My Workers Compensalian lnsuTnntt court.and Policy n[umWr art: e
Carrier. \Q \�- ` L/N17alicy No:a . a CI�sr>— V7
CERIF'�f ICATEOFEXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(This scoutsi need at W completed filar permit is faranc hundred dollars(SIM)
or less.)
I certify Nm in the Performance c tof the work for which this Permit is issued,I shall not
employ any person in any�t f s so az to become subject to out Compensation
Laws OTCaliroin�ia.Be
I S{r�"3
Applicant EZ�,.1
NOTICE TO APPLIC :IL after making this Cenifcam of Exemption,you should
(.come whjcn m the orkcr's Compensation provisions of Nc Labor CMc,you muR
Q2, faMvom comply On such provisions or this permit shell he deemed rewoed.
Z O CONSTRUCTION LENDING AGENCY
[-+ Thereby affirm Nm there is a construction lending agency lot their performance,of
7 the work for which this permit is Wood Sec.309'1.Civ.C.)
Lender's Name
L4 Lcodeis Address
t.)Q 1 ceNfy door 1 have mad this application and tam Nes the aWw information is
carton.l agree to comply with all city and county ordinances and sum laws relating to
C)`• building construction,and hereby suthoma mpres rnati.ms of his City to enter upon me
W abov-netts uned pmKrLy for inspecme P ximuss.
(We)agree to save,indemnify and keep harmless the City of Cupertino again
ti N liabilities,judgments,costs and expenses which may in anyway acema against said Gst
rp f
V z of this Permit.
APPLICANTCof the UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Die
SOURC,a REGU NS. s4to'
/7 / a
Re-roofs
�iglodts phi VContrxctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
all dam applicant or future building occupant store or handle haiafdous material
u dtfined by the Cupenino Municipal Code,.Chapter 9.12,and the Hcaln and Safety
Cede.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes rO
\
Will the applicant of future building occupant tau equipment athrombusaz If a roof is installed without first obtaining an inspection,I agree to remove
Mona which g
emit horanus air contaminants defined by she Bay Arca Air Quality Management
District? ail new materials for inspection.
❑secs ti U
I have mad Ne hammods materials requimmcnts under Chapter 6.95 of Ne Califon
ma Health&SafetyC We,,Sections 25505,25533 and 25534.1 undersand thm if the building
does not currently have a mnam char it is my responsibility m netity rhe accupana of me
tequimencroxwhibmust WmelpdermissemaOf.CenmcamofOccupancy Signature of Applicant Date
Owner
or AinDole All roof coverings to be Class "B"or better
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 35618044 . 00
DATE ISSUED. . . . . . . : 08/18/2004
RECEIPT # . . . . . . . . . : 26737
REFERENCE ID # . . . : 04080155
SITE ADDRESS . . . . . : 21722 COLUMBUS AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER YUWEI SHI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4713
RECEIVED FROM . . . . : MC SOLAR ENGINEERING
CONTRACTOR . . . . . . . : MIKE CLIFTON LIC # 23003
COMPANY MC SOLAR ENGINEERING
ADDRESS 1168 ASTER AVE
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
• TELEPHONE . . . . . . . . : (408) 261-1211
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -------- - ------------- -- -------- ---------- --- ------- ---------- - ---------
BENERGY PERMIT FEE 191 . 16 91 . 76 0 . 00 91 . 76 0 . 00
BPERMFEE VALUATION 12 , 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00
BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 .43 0 . 00
BPLANCHK PERMIT FEE 191 . 16 255 . 10 0 . 00 255 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMPOLE NO. FIXTURES 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 - 47 . 96 0 . 00
BSEISMICRE VALUATION 12 , 000 . 00 1 . 20 0 . 00 1 . 20 0 . 00
---------- ---------- -------- -- ------ ----
TOTAL PERMIT 656 . 18 0 . 00 656 . 18 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------- ----------- ------------ ----------------- -
CHECK 656 . 18 1992
TO'T'AL RECEIPT 656 . 18
•
ism
OCITY OF CUPERTINO* )8 0
CUP TYOF O PERMIT APPLICATION FORM
APN# % j' Date:
Building Address:�1 4 Mailing Address (if different from building address):
y-1 V
Owner's Name: Phone #:
Y S141 '-toss
Contractor: License #:
Contact: Phone: 0 Cupertino Business License#:
v / �2 CSt`t✓ Fax: viae k`ila(0:13(
Build1bg Permit Info:
Bldg Elec Plumb ❑ Mech ❑
Job Description: n 5A-&,k1 o4 5�
Residential Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
t a oop S�
AOLType of Construction: L Please check this box if the project is a
second-story addition: ❑
Project Size: Standard are ❑ Major ❑
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
zG737
1 of 3 ��� � ��
!CITY OF CUPERTIN(*
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTESAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
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 rinkler/Backflo PLUMBING
BPSTORM Stonn/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 Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP 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
2 of 3
WITY OF CUPERTINO*
CUP kTCITY OF
O PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting 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 Insl5ecti6n BUILDING.
BSVdIM 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
/ 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 Chane BUILDING
•
3 of 3
CITY OF CUPERTINO a. 1 OW v e v "`' I- 'g'Wim•',
BUILDING DIVISION PERMIT �C, oNTRAC,TQ,R INF09MATION W,
BUILDING ADDRESS: MC SOLAR ENGINEERING PERMIT No.04080155
91792 MIUDQUS; POT
OWNER'S NAME: PERMIT ISSUE DATE
10 YIJWPT qHT DOA
IS: SANITARY O OL NO.
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLOGELECr PLUMB MECH
t� o 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION
C I Iereby affirm Har 1 am Tim—under provisions of Chapter 9(commencing Job Description 2�f�
b with Swoon 1000)of Division 3 ofdm Business and Professions Code.and my license is I('a 11l`❑may
^Oy
in full forte and cf ttt. ^ SSI Io5 SOLAR ELECTRICITY ON ROOF ° �p� ®
,iyn Data ClwA /nLs Conuacor
£u "r A CT'SDECLAR N AUG 2y 2004
C 1 unde...d my plans shell he used republic re orris
;off Licensed Profcssionel ICp 110��
S OWNER-11U1lDER DECLARATION
i1 berehy affirm that 1 am exempt from the Convacsar's License Law for the ®e��
OO following reason.(Section 703I.3,Business and Professions Code:Any city ar County
x w which requires a permit to construct,alter,improve,demolish,or repair any nrucwte
m�'^ prior In its issuance.also requires the applicant for such permit to file a signed statement
��'<
door Wislicensed pursuanoHcpovioDMOfineContr000lU
r'swmC Law Sq.Ft. Floor Area Valua
pursuant tion
ax
d (commencing with Section 7")of Division 3 of me Business and Professions Coale)or
ad that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicants o a civil penalty of 398111�'IOr4I 0 0 Occupancy Type
rat mom than five hundred dollars(SKID).
El I,u owner of Elie property,or my employees with wages u lhcir sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Profey nm Core:Tho Canaacmrs Lic r6t law dw WE apply la an owner Of Required Inspections
property who Moi Ids or im proves Hereon,and who does suc h work hi mealf or through his
own employers,provided Het such improvements art not intended aroffered for sale.If,
however,the building or improvement is sold within one year ofcompledon.Ne owner
Wilder will has tk burden of moving that k did not build or improve for purpose of
said.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
comwm the project(Sec.]Olid,Business and Profcvuom Code:)Tire Codir ctori Li
cense Law dos not apply m an owner of property who builds or improve thereon.and
who contracts for such pmjacls with a eontiacmKs)lianred pursuant to the Commclala
License law.
O'I am caempt under Sao .B A,P C for this mown
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declaration:
haw and will maintain a Certificate of Consent m sdl6insum for Worker's Compen-
sation,as provided far by Second 3700 of the labor Code,for the pdrformance of the
work for which this permit is issued.
Khave and will maintain Workers Compensation Insurance.as,mquined by Section
3of the Labor Code,for He Performance of the work for which this permit is issued.
My Weisner Campensauoyn lnsionso a car and Policy'number art:
Carrier: 5X3 C T UNholicy No.T,�Q��a �mL)
R IFICATE OF EXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not IN completed if the Permit is forone hundred dollars($10(f
or less)
1 certify that in the performmanancencIof the work for which this Permit Is issued,10.11 not
employ any person in any f R w as m become him,1.do,Workers'Campensauon
Laws of California.Du ~If�"'t
Applicant
NOTICE TO APPIUC :If,after me aking this Cenificaof Exemption.you should
become suhjea u the ohci s Conmostauon provisions of He Labor Code,you must
.J Z forthwith comply with such provisions of this permit shall lid deemed mvokdd.
z
CONSTRUCTION LENDING AGENCY
E-t I hereby affirm Hal Nem is a eorstruction lending agency for lie Nfiformanc of
a the work for which thin permit u issued(Sec.3091,Co.C.)
QLendces Namc
z lender's Address
U Q 1 certify that 1 have rad this application and sore Hal the above infamatiun is
Ly P correct.l agree to comply with all city and county ordinances and rule laws reading in
0U Wilding construction,and hereby authodo rePrcatmadies or His city in came upon He
LS.1 above-mentioned property for inspection purposes
(~
CL We)agree to save,indemnify and keep harmless the City of Cupertino against
re- liedliue.judgmcnts.cmu and a.,.which may in say way accrue against said City
U Z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: D e
SOUt,U NS. FIlA
0 Re-roofs
ate li nVCrntnctor Date -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
01 the applicant or future building Occupanl arm or handle hazardous material
u defined by the Cupenlno Municipal Code.Chapter 9.12,and the Health and Safety
Code. El Y.zss3z(an All roofs shall be inspected prior to an roofing material beim
El Y. (g a . P P Y g g installed.
Will the aPplicans or future Wildinga¢upant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t harardnus air comaminan¢u defined by the Bay Area Air Quality Managcmcnr all new materials for inspection.
ndcB
O Yes Wr
I have mad He haoN Rus mmasialsmquimm nu under Claper 6.95 of the Califon
ria Halth&Safely Code.Scctiwu 25505.25533 anJ 25534.1 undersuM Hazif the building
does not currently haw a leant fied it is my respomibility to notify He occupant Of the
requirements whi h must W met prior to issuance ora Ccnilicarc of arrancy_ Signature of Applicant Date
Owner car .gem Data All roof coverings to be Class"B"or better