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15080075Z1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21860 ALCAZAR AVE CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15080075 OWNER'S NAME: RAJRUPA GHOSH 775 FIERO LN STE 200 DATE ISSUED: 08/10/2015 OWNER'S PHONE: 4085960291 SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL ROOF TOP, FLUSH MOUNTED 23 PV MODULES License ClassC Lic. # �tq (5.9 Contractor Date (t5 5 KW) I r affirm that I am censed 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: $12300 performance of the work for which this permit is issued. 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. APN Number: 35714036.00 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 180 D T ISSUANCE OR WIDAM 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 OM L LED 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 Is Date: CJ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. j / RE -ROOFS: Signat Date (� (� 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: 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 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). 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 I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 255 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorize gent: Date: permit is issued. 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 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 AE (408) 777-3228 - FAX (408) 777-3333 - buildingna.cupertino.org PROJECTADDRESS A APN# IL4 OWNERNAME PHONE(ap��.¢� E-MAIL STREET ADDRESS, ® _ LC CITY, STATE, ZIP CONTACT NAME �) m� PHONE 0 ° �` o Ck - s L U � E STREET ADDRESS CITY, STATE, ZIP FAX .Zv00r%jvt „c(L7 S -V" ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME@B, / LICENSE NUMBER y - f y . (g LICENSE TYP Q BUS. LIC 9 COMPANY NAT4E4 i��,� 4 L i s� E -MAIL STREET ADDRESS & r CITY, STATE, ZIP `3 e« d ` f ` PHONJ ARCHITECT/ENGII�'EER NAME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE 0 Yes ❑ NO -SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: ORSOLARPANELS: NUMBER OFPANELSMN11TS: KILOWATTS (COMMERCIAL ONLY): TOTALVALUATION: �S DESCRIPTION' OF WORK a `s�[✓� �,�j� �� \ �� air �'I By my signature below, I certify to each of the following: I am the property owner or authorized agent to on the property oehalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I 9EFee to comply with all applicable local ordinances and state laws relating to building co ruction. I a rize representatives of Cupertino to enter the above -id e tiifiedp perry for inspection purposes. Signature of Applicant/Agent: Date: C c) �s SUPPLEMENTAL INFORMATION REQUIRED L,x�{"e+'Cy tDl.l� �+�,�+�i't�b. '5j�'4 ri NO OT��(OUITE�2 "my � PT,'Wpp_2011.doc revised 03/16/11 CITE' OF CUPERTINO FEE ESTIMATOR —RtTFT,D11NG T)TVTCrnN Afech. Plrrrr C.'h >.ck 1'177;;;b. Nat'l Che' 1_1ec% Platz Check /ecl7. Perr7lit Fee; Plumb. Permit Fee: Isle. c'. Pe'rinir Fee: Orlher Uec•h. Insp.E17-- Other Phanb Ins;E1__L_ Other lslec. Insp. i -loch. Imp. Fe . Pl711711). liusp. Fee: Oec. Imp. hire: NUIE Luus estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etn ). These fees Ore hasad nn tho nrotimist"m isfnrsentins nvni/nhlo -d Ora n hi Ore ocfimnan f nnlnn/ ihr ))orif for odds 11 ;"fn FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) 21860 ALCAZAR AVE DATE: 08/10/2015 I REVIEWED BY: MELISSA IvaADDRESS: APN: 357 14 036 BP#: -VALUATION: 1$12,300 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: $0.00 PENTAMATION SOLAR -RES PERMIT TYPE: WORK INSTALL ROOF TOP FLUSH MOUNTED 23 PV MODULES 5.9 k SCOPE $0.00 Afech. Plrrrr C.'h >.ck 1'177;;;b. Nat'l Che' 1_1ec% Platz Check /ecl7. Perr7lit Fee; Plumb. Permit Fee: Isle. c'. Pe'rinir Fee: Orlher Uec•h. Insp.E17-- Other Phanb Ins;E1__L_ Other lslec. Insp. i -loch. Imp. Fe . Pl711711). liusp. Fee: Oec. Imp. hire: NUIE Luus estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etn ). These fees Ore hasad nn tho nrotimist"m isfnrsentins nvni/nhlo -d Ora n hi Ore ocfimnan f nnlnn/ ihr ))orif for odds 11 ;"fn FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System $236.00 IPHOTOVRES Photovoltaic System Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0 0 hrs $0.00 PME Unit -Fee: $0.00 PME Permit Fee: $0.00 Co1zS1t•11(.ti0r7 Tax: 7-1- Acbninistrolive Feer: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 fr�al,el I)r;c•urnc;:ntatiart Fees:� Strong Motion Fee: 1BSEISMICR $1.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SiTBTOTAY.S = $2.60 $236.00 .TOTAL FEE. = $238.60 Revised: 07/02/2015