15050090 CI'�'Y OF CUPERTINO BUILDING PERMIT
BiIg1L�IlIVG AdDdDRE55: 21905 CORTE MADERA LN CONTRACTOR:SUN WORK PERMIT NO: 15050090
RENEWABLE ENERGY PROJECTS
O�'IVIEQd'S NAME: BENNETT ELIZABETH AND CHRISTOP 477 VALLEY WAY DATE ISSiIED:OS/I S/2015
OV1'IV]El�'S PHONE: 4086769405 MILPITAS,CA 95035 PHONE NO:(650)520-9918
I!d 1LICENSED CONTRACTOR'S DECLARAT[ON JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL �
q�U�3 Z INSTALL(N) 11 ROOF TOP FLUSI�MOUNTED PV
License Class Cy 6 Lic.# MODULES�
Contractor `� /75 Date
S Is �m1S 2'8KW
II hereby afTirm that I am licensed u�der 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.
ll hereby afTirm under penalty of perjury one of the following hvo declavations:
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
perfortnance of the work for which this pertnit is issued. Sq.Ft Floor Area: Valuation:$9000
�/j) l have and will maintain Worker's Compensation lnsurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32645035.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is pERMIT EXPIRES IF WORK IS NOT STARTED
cortect.I agree to comply with all city and county ordinances and state laws relating wIT�iIl�i 180 DAY 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 DAY VI LAST EI) 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 pertnit. Additionally,the applicant understands and will comply ed by: Da .
with all non-point source regulations per the Cupertino Municipal Code,Section
9.I 8.
RE-ROOFS:
Signature I Date 5 /5 �1� 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:
g hereby afTirm 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 struc[ure is no[intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively con[racting with licensed contractors to HAZARDOiJS 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
➢hereby afTirm 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �� /5 �p)S
permit is issued.
Owner or authorized agent: ��iC�! dDate:
[certify that in the performance of the work for which this permit is issued,I shall
no[employ ar�y person in any manner so as[o become subjec[to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,I CONSTRiICTION LENDING AGENCY
become subjec[[o the Worker's Compensation provisions of[he Labor Code,1 must [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
APPLICAIVT CERTIFICATION Lender's Address
1 certify that I have read this application and state that the above infortnation is
cortect.I agree to comply with all city and cowty 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 agains[liabili[ies,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 wiIl compIy
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21905 COR'CE MADERA LN DATE: 0511512015 REVIEWED BY: MELISSA
APN: 326 45 035 BP#: � *VALUATION: $9,000
*t�ERMIT'I'YPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
t�fltIMAR� SFD or Duplex PENTAMATION SOLAR-RES
UJSE: PERMIT TYPE: �
��W� INSTALL N 11 ROOF TOP FLUSH MOUNTED PV MODULES 2.8KW
���PE
1�ecli. Plun C"h�rck Pl�inrh. Plun('l��rck f�'lec. 1'lan C"heck
�lleclr. 1'ermil Fee: 1'lwnb. Fcrrnil P'ee: 1�li;c. F�srn�.it r'ee.:
Or7�er Alerh. In.rp. QI/�er�Plirmh ln,s��. Ot/ier 1�lec.Inap.
J-lecli.buE�.F'c�e: Pl7rnib. /usp. /�Ee: Li(ec./ns�. 1�'ee:
NOTE: This esdmate does not inelude jees due to other Departments(i.�Planning,Public Works,Fire,Sanitary Sewer Distriet,Sehool
District,ete. . These ees are based on t/ee relimina in ormation avai[able and are on[ an estimat� Contact the De t or addn'l in o.
�EE ITEMS (Fee Resolution 11-053 L . 7/1,�13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 � # Alternative Energy System
Suppl. PC Fee: � Reg. � OT p,p hrs $0.00 $236.00 1PHo7'OV�s Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT p,p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Curislructi��rz Ta.r:
�ldminisb�ativcr Fc�e: �
Work Without Permit? � Yes � No $0.00 �
Advanced PlanninQ Fee: $0.00 Select a Non-Residential (�
Building or Structure �
7ru��cl Doci�rnc�ncali��n Fcaes: �
Stron�Motion Fee: �BSEISMlCR $1.17 Select an Administrative Item
Bld�Stds Commission Fee: �BCBSC $1.00
SUBTOTALS: $2.17 $236.00 TOTAL FEE: $238.17
Revised: 0 510 7/2 0 1 5