15050148-EXPIREDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21515 ADDINGTON CT
CONTRACTOR: REC SOLAR, INC.
PERMIT NO: 15050148
OWNER'S NAME: SETO BIT-LEUNG AND RUBY
775 FIERO LN STE 200
DATE ISSUED: 05/26/2015
OWNER'S PHONE: 4082534649
SAN LUIS OBISPO, CA 93401
PHONE NO: (888)657-6527
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL El
SOLAR PANEL INSTALLATION - 26 MODULES WITH 6.8
License Class C' Lk�o Lic. # —7
KW
f
CONVERTER AND INSTALL NEW 125 AMP PANEL
Contractop� 1 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:
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: $14200
performance of the work for which this permit is issued.
"e and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35622027.00
Occupancy Type:
'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
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 INSPN76
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
/ e-5;.
S�./. ca ''`N v r Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by.
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9 18.
BIZ
Signatu Date S 2e
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, l 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)
1, 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. [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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sec 'ons 2550 3, and 25534.
�" S -
permitor
permit is issued.
au or' gent: Date:
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
CONSTRUCTION LENDING AGENCY
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
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 -1 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
Licatsed Profomional
9 18.
Signature Date
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingO)cupertino.org
PROJECT ADDRESS ^ 1S- l �C_t
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APN # -3 S_ (,.2 2
OWNER NAME PHONE C, E-MAIL
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STREET ADDRESS i i
CITY, STATE, ZIP FAX
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STREET ADDRESS O ^ r
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FAX S� N r V Ino C • C
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME C"( _ LICENSE NTUMBER S�I LICENSE TYPE _�1
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BUS. LIC N
COMPANY NAME
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PHON
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
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 ❑ Yes ❑ NO
LAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OFPANELS/UN1T5:�J KILOWATTS(C-emm2ft""d"M: /� Q
TOTAL VALUATION: t r
DESCRIPTION OF WORK
�� Z�� ►.�� tZS
By my signature below, I certify to each oft following: I am the property owner or authorized agent to act on ovmer's be e r
application and the information I have prov' ed is correct. I have read the Description of Work and verify it is accurate. I agree mply with all a ocal
ordinances and state laws relating to buil construct' or cepFes tatives of Cupertino to enter the above-identi inspection purposes.
Agent: 11 — C -/-2-f fid
Signature ofApplica Date:
LE NATION REQUIRED
SUPPMENTAL IN
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277
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P I,App_2011. doc revised 03/16/11
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CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ft ,{ ,x t L'j ✓ '.�'fi`1, S i�.Ch $ yf6 C .kP4'Y
. fita•a, �;� �u a r � �`�'r �r 55., , a �
ADDRESS: 21515 ADDINGTON CT
DATE: 05/26/2015
REVIEWED BY: PAUL
Elec. Plan Check 0.0 hrs $0.00
APN: 356 22 027
BP#: O
*VALUATION: 1$14,20d
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
InNp.1'rc:
ENTAMATION SOLAR -RES
FVIERMUPTYPE: 14
WORK I
SOLAR PANEL INSTALLATION - 26 MODULES WITH 6.8 KW CONVERTER AND INSTALL NEW
SCOPE 1125
AMP PANEL
ft ,{ ,x t L'j ✓ '.�'fi`1, S i�.Ch $ yf6 C .kP4'Y
. fita•a, �;� �u a r � �`�'r �r 55., , a �
rvl, r +"fit hrs �.r�tai..� .��P°, a,�.,us�+.
Alva b, Plf.,,n Check
1'r;:nt'. Nan
Elec. Plan Check 0.0 hrs $0.00
,if -h t'erwif Ff! :,
Pl,r 1,,. Per-nir I've:
Elec. Permit Fee: IEPERMIT
),irrr' Akch. h,�p
C)rher P/„f„h r, , .
Other Elea Insp. 0.0 hrs $48.00
InNp.1'rc:
/'how'). it . 1c_.
L(e:c. Insp. Fee:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These lees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'1 into_
FEE ITEMS (Fee Resolution 11-053 EA.' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
IPKOTOVRES Photovoltaic System
Suppl. PC Fee: Q Reg. () OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
125 amps
$48.00
Electrical
IBELEC200Services
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tu:r:
Administrative Fee: 1ADMIN
$45.00
Q
G
Work Without Permit? Q Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.85
Select an Administrative Item
Blda Stds Commission Fee: IBCBSC
$1.00
n, S[�BT'A>JS
$143.85
$284.00
�
}�T� >E�>E.r
$427.85
Revised: 05/07/2015