11010150I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10415 IMPERIAL AVE
OWNER'S NAME:
_W_ LICENSED CONTRACTOR'S DECLARATION
License Class C —10 Lic. # ROE 6:7 9_
Contractor JA
_ _� Date
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:
1. 1 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.
2. 1 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 understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature ( — Date
0 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. 1, 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:
1. 1 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.
2. 1 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.
3. 1 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 may accrue 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.
Signature — Date
CONTRACTOR: GREEN LEAF SOLAR & PERMIT NO: 110 10 150
ELECTRIC
667 N 12TH ST DATE ISSUED: 01/27/2011
SAN JOSE, CA 95112 PHONE NO: (408) 691-4743
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
INSTALL A 4.2 KW SOLAR SYSTEM ON A SINGLE STORY
ROOF. ARRAY PITCH IS SAME AS ROOF PITCH 4:12.24
PANELS.
Sq. Ft Floor Area: I Valuation: $16800
APN Number: 35719100.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
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. 1 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 Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner oc kuthorized agent:
� =_Z� Date:
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 Add
ARCHITECT'S DE!LLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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A,Ivch. Plan Chec k phimb. Plur; Owc.
Plot: ��n Chv,�,k
Flte.( Fee:
oflief-Mech, ln�p, Odle/. 01her F, fnsp
Wech. Imp. Fee. 1,11m1h. I " 1 c ( Inspr. F(! e -
NOTF.- Thew fees arp haspdn" 1hp nroliminary informalinn availahlo and arp ank an poirnato- Cnntart tho DPW fnr addn 11 infn-
FEE ITEMS (Fee Resohilion 09-051 fff 7/1110)
DDRESS: 10415 imperial ave.
7DATE: 01/27/2011
REVIEWED BY: bobs.
APN: 5-151) H 4w
BP4: 110101,56
*VALUATION: 1$16,800,
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
USE: T
ENTAMATION
PERMIT TYPE: SOLAR -RES
WORK
q�solar panels at existinq sfd rooftop.
[t��t
SCOPE
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A,Ivch. Plan Chec k phimb. Plur; Owc.
Plot: ��n Chv,�,k
Flte.( Fee:
oflief-Mech, ln�p, Odle/. 01her F, fnsp
Wech. Imp. Fee. 1,11m1h. I " 1 c ( Inspr. F(! e -
NOTF.- Thew fees arp haspdn" 1hp nroliminary informalinn availahlo and arp ank an poirnato- Cnntart tho DPW fnr addn 11 infn-
FEE ITEMS (Fee Resohilion 09-051 fff 7/1110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$207.001
Photovoltaic System
ISOLARRES I
'A
Suppl. PC Fee: G Reg. 0 OT
$0.001
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consfruction Ta..N-
Acoustical Fee: 0 Yes (E) No
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.... . ... . .......
A,Ivch. Plan Chec k phimb. Plur; Owc.
Plot: ��n Chv,�,k
Flte.( Fee:
oflief-Mech, ln�p, Odle/. 01her F, fnsp
Wech. Imp. Fee. 1,11m1h. I " 1 c ( Inspr. F(! e -
NOTF.- Thew fees arp haspdn" 1hp nroliminary informalinn availahlo and arp ank an poirnato- Cnntart tho DPW fnr addn 11 infn-
FEE ITEMS (Fee Resohilion 09-051 fff 7/1110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$207.001
Photovoltaic System
ISOLARRES I
'A
Suppl. PC Fee: G Reg. 0 OT
$0.001
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consfruction Ta..N-
Acoustical Fee: 0 Yes (E) No
$0.00
0
(D
Work Without Permit? 0 Yes 0 No
$0.00
$0.00
Select a Non -Residential
Building or Structure
I
0
'A
Travel Docomentaiion
Strony, Motion Fee: IBSEISMICR
$1.68
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$2.68
_W_ORWW��a,( gp�.
$207.00 $209.68
Revised: 0 1 /15/2011