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04080155 (2) 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 I 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 Cerdficam 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 Cenificam 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 I 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