15060141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10744 BROOKWELL DR I CONTRACTOR: HIGHLIGHT SOLAR PERMIT NO: 15060141
I OWNER'S NAME: YANG XIANGYING ET AL 13554 PARKLAND AVE I DATE ISSUED: 06/22/2015 1
OWNER'S PHONE: 4089605961 1 SAN JOSE, CA 95117 1 PHONE NO: (408) 489 -9273 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class U 1 6 0 3 716 Lic. # C L( 6
Contractor Date 02
I hereby affirm Wat I a 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
performance of the work for which this permit is issued.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 sour a regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date G 6' Z Z
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
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:
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
performance of the work for which this permit is issued.
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
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, l
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.
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
INSTALLATION OF ROOF MOUNTED SOLAR (12
MODULES)(3.06 KW).
Sq. Ft Floor Area: I Valuation: $13228
APN Number: 36921039.00 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: ,��/V, �G Date: 6 !;�2 -/f
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. I 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 2 a5, 25533, and 25534.
Owner or authorized agent: Date: Z Z
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
i
�.0
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10744 BROOKWELL DR I CONTRACTOR: HIGHLIGHT SOLAR PERMIT NO: 15060141 1
OWNER'S NAME: YANG XIANGYING ET AL
'S PHONE: 4089605961
LICENSED CONTRACTOR'S DECLARATION
License Class 116 0 3A Lic. #
Contractor � I S ° a Date o
I hereby affirn rat 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
performance of the work for which this permit is issued.
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
permit is issued.
APPLICANT CERTIFICATION
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,
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 sourc egulations per the Cupertino Municipal Code, Section
9.18.
Date �)
I-1 OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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:
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
performance of the work for which this permit is issued.
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
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
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
3554 PARKLAND AVE I DATE ISSUED: 06/22/2015
SAN JOSE, CA 95117 1 PHONE NO: (408) 489 -9273
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
INSTALLATION OF ROOF MOUNTED SOLAR 12
MODULES- 3.06KW
Rev #1 - Upgrade (E) panel to new 200 Amp Panel
Sq. Ft Floor Area: I Valuation: $13228
APN Number: 36921039.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPEC�TION.
Issued by: L�Z 0 5(ftt 1I � 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 Cu ertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 505, 25533, and 25534.
Owner or authorized agent: Date:O o G
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
,�- ASS
•
GENERAL PERMIT APPLICATION 0 1,MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVI ION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 l5%0 1 +,
(408) 777 -3228 • FAX (408) 777 -3333 • building d( cupertino.orq L{IJ M b
IWI
❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS '^
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APN C �� l 1
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OWNTERNAME
PHONE
E- MAIL
STREETADDRESS
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CITY, STATE, ZIP y
FAX
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C \k I o
CONTACT NAME
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STREETADDRESS
CITY, STATE, ZIP
CAP
FAX
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❑ OWNER ❑ OWNER - BUILDER
❑ OwNERAGENT ft, CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMB R
LICENSE TYPE
BUS. LIC
n� LiJ
C L{
COMPANY NAME
E -MAIL
FAX
Vk4 0,
STREETADDRESS
CITY, STATE, ZIP
►c
PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER U
BUS. LIC R
COMPANY NAME
E -MAIL
FAX
STREETADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD u DUPLEX
❑ MULTI - FAMILY
PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO FLOOD ZONTE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
c A
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TOTAL VALUATION: � � �
22 3 6 0.
RECEIVED Bl �� ��
U
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have
provided ' 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 to building struction. I authorize representatives of Cupertino to enter the above- identif dPr oper I Lr inspection purposes.
Date:
Si,-;nature ofApplicant/Agent:
t
SUPP MENTAL INFORMATION REQUIRED
oICE oNti
IISE
�OVERTHExCC![J�1TER
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A1PPr1flscApp_M1.doc revised 06121111
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•
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building aQcupertino.org
Ll
PROJECT ADDRESS -
APN '�.�/ CM,
`
OWNER NAME
PHONE 0r' LI E -MAIL
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[ a
STREET ADDRESS CITY, STATE, ZIP FAX
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I e \ U `r CA L56/
CONTACT NAME
PHONE
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STREET ADDRESSZ �Cli v�
CITY, S-", ZIP
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FAX^^^EEE"'
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❑ OWNER ❑ OWNER- BUILDER ❑ ONTIERAGENT 101,'11CTOR ❑ CONTRACTORAGENT ❑ ARc=,cT ❑ ENGINEER
❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME n LICENSE NUMBER 0 .J-7 6
LICENSE TYPE L( l/ p
BUS. LIC 9
�
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP _ -
PHONE
35
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2
ARCHITECT/ENGINEER NAME
LICENSE NUI,4BER
BUS. LIC d
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi - Family
PROJECT IN WILD LAND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ NO
FLOOD ZONE ❑ Yes ❑ No
STRU RE:
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 1 KILOWATTS (COMMERCIAL ONLY): 3,06 k
TOTAL VALUATION: � 1 � � Z
` . U
DESCRIPTION OF WORK
0 C+ ti 1n G. u
t � s
RECEIVED $Y `�`
_
By my signature below, I certify to each of the following: I am the property ovmer or authorized aeent to act on the property owner's behalf. I have read this
application and the information I have provide 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 to buildin onstruc ' . I authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: dt — Date: 06- pC 2
ST,.PfPLEMENTAL INFORIMATION REQUIRED
r oFiicEUS> p.L�
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PVApp_2011.doc revised 03116/11
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Fm_� CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1A
ADDRESS: 10744 Brookwell Dr
DATE: 06/22/2015
REVIEWED BY: Paul
APN: 369 21 039
BP #: �` j
*VALUATION: $13,228
rPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (j) Reg. Cl OT
PENTAMATION SOLAR -RES
PERMIT TYPE:
wORK
Installation of roof mounted solar 12 modules 3.06 kM.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt oir )_ Thpco fops aro hacod nn tho nroliminary infnrmntinn availahlo and aro only an ectimalp- Contact tho Dent far addn'I info.
FEE ITEMS (Fee Resolution 11 -053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (j) Reg. Cl OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee :Q Reg. Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? Yes E) No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non - Residential
Building or Structure
Stronj; Motion Fee: IBSEISMICR
$1.72
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS.
$2.72
$236.00
TOTAL FEE:
1 $238.72
Revised: 05/07/2015
FI-M-7 CITY OF CUPERTINO 60601
'
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10744 BROOKWELL DR.
DATE: 07/0812015
REVIEWED BY: PAUL
UNITS
APN: 369 21 039
BP #:
'VALUATION: Iso
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
Amps
PENTAMATION 1 REAP2
PERMIT TYPE:
WORK
Rev #1 - U rade E panel to new 200 Am Panel
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
�: 'r
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Services
1ERT <200
Other Elec. Insp. 0.0 hrs $48.00
200
Amps
$48
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff.' 711/13)
FEE
�: 'r
Elec. Plan Check 0.0 hrs $0.00
.. .
Elec. Permit Fee: IEPERMIT
t -�
Other Elec. Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff.' 711/13)
FEE
QTY /FEE
MISC ITEMS
.. .
( _
PME Plan Check:
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
. Pl' � lErrttri
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$189.00
$0.001 TOTAL FEE:
$189.00
Revised: 07/02/2015
pp
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with overhead obstructions such as tree limbs, wires or signs.
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