15070142CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10360 E ESTATES DR
CONTRACTOR: ELITE ELECTRIC INC
PERMIT NO: 15070142
OWNER'S NAME: MOK SAMMY
9415 BELLEGRAVE AVE
DATE ISSUED: 07/20/2015
OWNER'S PHONE: 4087778883
RIVERSIDE, CA 92509
PHONE NO: (915) 681 -5811
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
ADD 10 ROOF TOP, FLUSH MOUNTED PV MODULES
License Class C 1 O Lic. # 2,-A 2
(3.1KW)
�^ _ p e�C, `
��.�{� � ° L�J '
TO EXPAND TO THE (E) PV SYSTEM
Contractor��� x'T � Date 1
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:
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: $12000
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 which this
APN Number: 36914001.00
Occupancy Type:
permit is issued.
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
Issued byy� /�/ f . cf� Date: 7 '' a�
y5
granting of this permit. Additionally, the applicant understands and will comply
,ye
with all non -p e regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date 1, '2 1S
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
❑ OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I 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
I 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
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio 505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
7 ,
Owner or authorized agent: Dater
permit is issued.
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, l
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, l must
l 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 l 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
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinp(o1cupertino.or4
/SZ) /-01V z
PROJECT ADDRESS APN 9 ( _ [1 l tc,
OWt,cRNAM PHONE (7�� 1441L
STREET ADDRESS C CITY, STATaE}Z1P O` l n FAX
J �
PHONE �t� E -MA \" 1
CONTACT NAME _ O \So 1
F IP
STREET ADDRESS c m 1� � CITY, STE,Z�
❑ ORN--R ❑ OWNTER- BUILDER ❑ ORT'ERAGENT XCONrFRACTOR ❑ CONTRACTOR AGENT ❑ kRC=rCT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAT4Ee`�C �` _ LICENSE�KIBER' ` LICENSE TYPE
BUS. LIC�
c. "1
COMPANY NAME
E -M,�IL
FAX
STREET ADDRESS
CH 1 � Bell Owe_
STATE, ZIP
�, 60 �
PHONE
a'o 0
>
.r �
5 to 2 117
ARCHITECT /ENGINEER NAME
LICENSE NUMBER
I BUS. LIC
`
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF (WSFD or Duplex ❑ Multi - Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes A/ NO
FLOOD ZONE ❑ Yesp'Q NO
STRUCTURE:
ACLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER Y.EATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: ` KILOWATTS (COMMERCI.AL ONLlO: -3
TOTAL VALUATION:
fj
z
DESCRIPTION OF WORK
�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o ave read this
application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating (ding constru uthorize representatives of Cupertino to enter the above- identified property for inspection purposes.
Signature ofApplicant/Agent: Date: %
MENTAL INFOR. NATION REQUIRED
o> FICEt,sE'oNLY
❑
L�
OFER TJCOURTER t
+�/.•SS -�....
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IM
PV,4pp_2011.doc revised 03/16/11
!Nt
Fm_� CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt- otr_ )_ Thace fees are ha.ced an the nreliminary information avoilahle and are nnly an v.ctimaty_ Cnntart the Dent for addn'1 info_
FEE ITEMS (Fee Resolution 11 -053 Eff.' 7,11;13)
10360 E ESTATES DR
DATE: 07/20/2015
REVIEWED BY: MELISSA
ImADDRESS:
APN: 36914 001
BP #: lsLO J c:�,
*VALUATION:
j$12,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: E) Reg. Q OT
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
ADD 10 ROOFTOP, FLUSH MOUNTED PV MODULES (3.1 kW) TO EXPAND TO THEE PV
SCOPE
SYSTEM
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt- otr_ )_ Thace fees are ha.ced an the nreliminary information avoilahle and are nnly an v.ctimaty_ Cnntart the Dent for addn'1 info_
FEE ITEMS (Fee Resolution 11 -053 Eff.' 7,11;13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: E) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg.
Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T-T
4
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
Q
0
Strong Motion Fee:
1BSEISMICR
$1.56
Select an Administrative Item
1
Bldg Stds Commission Fee: 1BCBSC
$1.001
SUBTOTALS:
$2.561
$236.001
TOTAL FEE:
1 $238.56
Revised: 07/02/2015
ffEfLZ1171T7ffE ELECTRIC INC
Credit Card Authorization
April 8, 2015
To Whom it Concerns,
Zorana Carter has my permission to use my Elite Electric Capital One MasterCard to purchase
permits, building licenses and materials in connection with Solar PV installation projects in our
Bay Area Division. She has the card in her possession.
Please feel free to contact me with any questions at (510) 859 -6999.
Thank you,
f �
Kr'sta Olson
Bay Area Division Manager
CA C- I Of A 18242 9415 Ile Ila-rave Ave. ■ River:sidc. CA 93509 ■ Phone (()5 I) 681 -5311 ■ Fax (951) 681 -9543 A% ?, 143773
840 66'x' Avc. ■ Oakland. CA 94621 ■ Phone (510) 562-1170 ■ Fax (510) 502-1149
ww,N.elite- cIcoricinc.com
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