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09050008apZ m0 �Zi rF� ;yU 'QN iyOaO�i ka4 —Z< FFC CITY OF CUPERTINO BUILDING DIVISION PERMIT dlR NER'S NAME: ARCHrfEC IENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. , /JOJY 77� License Class 4' Date ,j/ 11 OContractor ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 0 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 and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. -t I am exempt under Sec. B & P C for this reason mer Date WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier. 4) r7J Policy No.: 3't -2 F 2- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or Icss) I certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers' Compensadon Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lcndees Address 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 in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. t, Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety ole. Section 25532(x)? 0 Yes $j No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes %No 1 have [tail the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Ccrificaic of Occupancy. Owner or authorized scent Date 4 Job Description INSTL ;;LSH MONTD SOLAR MODULS 36/175W Sq. Ft. Floor Area 326370:-9.00 Issued by: Re -roofs Type of Roof MCI Required Inspections Valuation Type All roofs :;hall 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 A Applicant Date . All roof coverings to be Class'''` or better r; i,:�IJJYJI1 JJJlJi, J11%r 1 JJ _ 1_J U, Fli I File Edit Actions Details Links Favorites Help .41 P-rm1i Ir�formahnn Permit Number 09050008 Status x C Closed Contractor x Defined Fields Master Number Notes Project SOLAR -RES Apply Date' 0510412009 AM Operator Permit Issue Date 0511212009 Operator Certificate Issued 0610$12009 Operator Certificate Type SQUARE FT. Certificate Number Calculated Value L�cahi:i In urrin r11 Address' I 10201 STONYDALE DR City/State/Zip CUPERTINO 1 APN 32637019.00 - - ---�� Unit patg Fnrity Inforrnatiur-, patg I Owner Name .I JOSEPH WILSON PALM Use Default ❑ Address Home - 10201STONYDALE DR City/State/Zip CUPERTINO CA PermitProperty Zoning Applicant Contractor x Defined Fields Permit Details Permit Type' SOLAR -RES RESIDENTIAL SOLAR PANEL Usage Class N/A ISI NON APPLICABLE Applied Value x 51000 SQUARE FT. 0 Calculated Value 0101 US C-404 Type 434 ill ALT: RESIDENTIAL Permit Form x AUTOPERM -PERMIT Ownership 1 -Private Project Size EXPRESS -EXPRESS 'ermit issued 05/12/2009 .nhor Fho ni irnnco nr an%e cnoriA rnnHihinnc fnr Fhic na miF CA 95014 Ir�Y=§a Ids 95014-1029 Purpose/Special Conditions �NSTL FLSH MONTD SOLAR MODULS 36/175LT SCANNED/ FILMED 8/2011 I[OAdd Default Text CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: OWNER'S NAME: ARCHITECTIENGINEER: 0 p LICENSED CONTRACTOR'S DECLARATION i u P 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing ;Zw with Section 70110) of Division 3 of the Business and Professions Coode, and my license is t a a in full force and effect. 7 / 3 j Z License Class a, tu:, Lic. q j F, w Date S/ 1 I O� Contractor ,,,t ARCHITECTS DECLARATION 1 g d 1 understand my plans shall be used as public records )aU .50 Licensed Professional OWNER -BUILDER DECLARATION 3 a 1 hereby affirm that I am exempt from the Contractor's License Law for the .00 following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure Zy prior to its issuance, also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 [— (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 60 $ -. 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 applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 and Professions Cotte: The Contractor's License Law does not apply to an owner of properly who builds orimprovess thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors U. cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec B & P C for this reason Owner Date _ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of dtc following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. �) G; Policy No.: 3`('Z F Z j 2 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is forone hundred dollars ($100) or less) 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 Workers' Compensation Laws of California Datc Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the tabor Code. you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY �1013 I hereby affirm that there is a convection lending agency for the performance of ❑: > the work fur which this permit is issued (Sec. 3097, Civ. C.) 0 Lenders Name Z Lenders Address V 0 1 certify that 1 have read this application and state that the above information is (y — correct. I agree to comply with all city and county ordinances and state laws relating to 0V building convection, and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against c13 liabilides,judgmcros, costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. . r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. _ ,-- -112- Signature of Applirant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantsiorc or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑Yes -ZNo Will the applicant or future building occupant use equipment or devices which croft hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes %No 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia HraIN & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. /�- a /1zir% Owner or authorimci agent Date AUI MINIMUM PERMIT NO. FEMM ISSUE DATE Job Description CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH INSTL FLSH MONTD SOLAR MODULS 36/175W , Ft. Floor Area 32637019.00 Required Inspections Issued by: Re -roofs Type of Roof Valuation Occupancy Type Date _S_�— /2 G 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'." or better D C/vs C,0a,F CITY OF CUPERTINO SOLAR PANEL CU CITY INO PERMIT APPLICATION FORM APN # _� ) (� 3 -- 0 � (i--1 v Fee ID Date: Building Address: Permit Type Owner's Name: v-vk 1 SOLARPANL Phone #: NO?) 731- 7792_ Contractor: Q Phone #: A l��G�hG/ jp�lfl° Fax ('kG'�� ►t0,7- yKO2 Contractor License #: )12577J Contact: Phone #: ��Gl ©.n 13e ✓� Fax #: 015) 7 i0- 59b `l Cupertino Business License #: Number of Panels[Units: Kilowatts (Commercial Only): Job Description: 1�►5 rq Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Residential Commercial ❑ Valuation (cost of project)- 15i,roo Green Points: 1.2 KW - 6 Points ❑ 2.4 KW - 12 Points ❑ 3.6 KW -18 Points 19 Quantity Fee ID Fee Description Fee Group Permit Type 1 SOLARPANL Commercial Solar Panel E SOLAR -COMM 1PHOTOVCOM Photovoltaic System Commercial E 1 PHOTOQP Photovoltaic Quasi Public E SOLAR -QUASI 1 BSEISMICO Seismic Commercial E 1 ELCPLNCK Plan Check Fee E 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES COMM & RESID 1 SOLARRES Residential Solar Panel E SOLAR -RES Revised 01/07/09 CITY OF CUPERTINO SOLAR PANEL OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1 PHOTOVRES Photovoltaic System Residential E 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B