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11010129CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6387 MYRTLEWOOD DR CONTRACTOR: QUALITY FIRST HOME PERMIT NO: 11010129 IMPROVEMENTS OWNER'S CITRUS HEIGHTS, CA 95610 PHONE NO: (916) 788-2921 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class O-' I Lic. ii F 7 S— 77 Z INSTALLING DOMESTIC HOT WATER SOLAR SYSTEM Contractor ,ZAt.! / Date Z / l / WITH ONE 4'X8' COLLECTOR ON ROOF 1 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. 1 hereby affirm under penalty of perjury one of the following two declarations: I 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 Sq. Ft Floor Area: Valuation: $8105 performance of the work for which this permit is issued. 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 this permit is issued. APN Number: 36917005.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by te: 1 with all 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I 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 the Health & Safety Code, /Z 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18, Signature Date FM-7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 6387 mrytlewood dr. DATE: 01/24/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: $8,105 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK install solar domestic hot waters stem SCOPE 1.clr. Plan A- ,,h. i"'oh. P"l-w it F'�tc�' 1, P�; ;, . r l', < . L:frc'. P"! ffi, Qlher 'Ifec ki. Ins[). Q : ,: 1 :.;., , : •. •.;Lj Orher Elc(. Insp,LJ ,ldech.-In.�p. I, Phimb h„ ;, F", kr. Insp. I -,re' NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 09-051 E(L 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $207.00 Photovoltaic System ISOLARRES Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee'O Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .)n_r Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? © Yes 0 No $0.00 Plannin Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Doc mewwion Fces. Strong Motion Fee: IBSEISMICR $0.81 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.81 $207.00 TOTAL FEE: $208.81 Revised: 01/15/2011