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15050067MA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21675 REGNART RD CONTRACTOR: HIGHLIGHT SOLAR PERMIT NO: 15050067 OWNER'S NAME: OMER & YAEL GILA 3554 PARKLAND AVE DATE ISSUED: 05/12/2015 OWN R'S PHONE: 6507067461 SAN JOSE, CA 95117 PHONE NO: (408) 489-9273 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL D INSTALL 10 ROOF TOP, FLUSH MOUNTED PV MODULES, / 9 License Class C "1f Lic. # (� ?� 3.0 Contractor S 0.(— Date b of �_ KW I hereby affirm that I amlicensed 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: 35624038.00 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 W IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 IT 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 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 Issu y: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 918. L RE -ROOFS: Signature Date l Z Z 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) 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. 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 Cupert* ro Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this l 1 Owner Dater permit is issued. or authorized agent: I certify that in the performance of the work for which this permit is issued, I shall iv 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 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 Codc, Scction Liccnscd Professional 9 18. Signature Date CUPERTINO PROJECT ADDRESS OWNERNAME�^ STREET ADDRESS) CONTACT STREET ADDRESS ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building o)cupertino.org V✓7 APN N 3 3— 6 rf -77-t / E-Mp`IL L M SU — -t-1-1 b� �� , n fl 1%10 CITY, STATE, ZIP , C,-1 PHONE Y - CITY, STATE, ,ZIP h FAX E-MAIL` �{ FAX -03?� C> l'1_I ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONIERAC 0RRNAMEU � `G" Ie( h LICENSE NUMBER LICENSE TYPE Bus. LIC 4 o - COMPANY NAME I t� _ 4 E -MAI i�C aQ � I FAX STREET ADDRESS CITY, STATE, ZIP , PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # FAX E-MAIL COMPANY NAME CITY, STATE, ZIP PHONE STREET ADDRESS OF ❑ SFD or Duplex [I Multi -Family PROJECT IN WILDLAND PROJECT IN No USE ElYes C]No FLOOD ZONE ❑Yes ❑ srxucruRE: ElCommercial URBAN INTERFACE AREA `C3ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING El OTHER: SOLAR PANELS KILOWATTS (COMMERCIAL ONLY): rl L� TOTAL VALUATION: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:/ rj DESCRIPTION OF WORK S P) "'Cj <a By my signature below, I certify to each of the following: I am the property owner or authorized agent to act n t property fnecom awith all applicable have fead tlocal application and the information I have provO ed is correct. I have read the Description of Work and verify i s accura P ordinances and state laws relating to bui g construction. I authorize representatives of Cupertino to ent the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED �r�4 i;'liA4 �0F41IdCU$�i�OJVI l , c. r PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21675 REGNART RD DATE: 05/12/2015 REVIEWED BY: MELISSA APN: 356 24 038 BP#: "VALUATION: 1$12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION SOLAR -RES USE: PERMIT TYPE: WORK INSTALL 10 ROOF TOP FLUSH MOUNTED PV MODULES 3.0 kW SCOPE ..�. s�;y ,t4 dna s,; .�, xr :,u'ya a ti ^�'",1 �. 'oril?f 4e:.fi �: v.,,,•, . �,. .r. '� fl "1&':,. x a,. ;• ::>aa4 r..�..n xJd -: ,< y1 nrrs�zr� ,�,� -rvr q-- 1AJ....,.� i L:..« �Nt-:� Ar-.�W[�{:fsy int, xgh t��-.. r�`�� i�r:��i S v`'�:' R �'T,nSg° 1k'�'wz.""i�lyyi..��. ]✓;,�'e'. �r1D��!,f,rh'r � �w s} 5q.,�, �94 ���.r �y.?3�y���'��{i,CmJ',,_:;�i g _ .:.. 'Y �a t. l�—e it �l'. �.¢� ,1��"v-rs�i l� *..:.Ai �-,, h�`fJk4., i?I X+YY ar Sir R.� t E � i���f(�_y�F4 Y h Y 11���:' �M yy'��v9."_iE R� ��...��1,,yy1l''Y47Y l(. J' � �+.3,, 14".•..1 �f��.t 1`.,'1:z"'"`5� v �'��y� {.—��l . b`�c`z•. �s � �i�.��7+„rr �1::s. �.. Ct iF .. �� �.� a 4,.r 4+`�' i.! 3 ia#"', p`w{,,,;��ta,:tr�� ,m : 31s�.fz,.C�Prz �� �ft4,,�`.5.��. �•,.,'°4C1.�(.. J. ��... i.;�� �,f amu,.=iWF!,Y �{`'i�'cr, al.J.l �` 1J'sr .,�'. e-. �. tl nt. �. i'H 3.t .. 4+1, i 1 .. Y..B '�fa � t.•.� Lfeah. Plan (.'heck Niwih. Plus ('hc'c1, Iilec:. Ilan ("he=ck F_,-,, 1'ePn i! Free: 1-Voin). Pcrnzit Fe r;: Is'fec. Pe7"1rn1 Peer' O1hwr aFec•h. Insp.0 1i1F,• P ,.(mb lrvp�. Other F;G.ec. Insp.Alech. Insh. Fe 1'1111111). hisp. Fee: Llcc�. /jun. Fee. $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT O Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con,'trnction /.(i1": ya kf�Y ii�J�F';�4RM, SVi Y.'"P`_ A(ministrative Fee: i � ISI fk �[� .iiE' $��•t• ..�. s�;y ,t4 dna s,; .�, xr :,u'ya a ti ^�'",1 �. 'oril?f 4e:.fi �: v.,,,•, . �,. .r. '� fl "1&':,. x a,. ;• ::>aa4 r..�..n xJd -: ,< y1 nrrs�zr� ,�,� -rvr q-- 1AJ....,.� i L:..« �Nt-:� Ar-.�W[�{:fsy int, xgh t��-.. r�`�� i�r:��i S v`'�:' R �'T,nSg° 1k'�'wz.""i�lyyi..��. ]✓;,�'e'. �r1D��!,f,rh'r � �w s} 5q.,�, �94 ���.r �y.?3�y���'��{i,CmJ',,_:;�i g _ .:.. 'Y �a t. l�—e it �l'. �.¢� ,1��"v-rs�i l� *..:.Ai �-,, h�`fJk4., i?I X+YY ar Sir R.� t E � i���f(�_y�F4 Y h Y 11���:' �M yy'��v9."_iE R� ��...��1,,yy1l''Y47Y l(. J' � �+.3,, 14".•..1 �f��.t 1`.,'1:z"'"`5� v �'��y� {.—��l . b`�c`z•. �s � �i�.��7+„rr �1::s. �.. Ct iF .. �� �.� a 4,.r 4+`�' i.! 3 ia#"', p`w{,,,;��ta,:tr�� ,m : 31s�.fz,.C�Prz �� �ft4,,�`.5.��. �•,.,'°4C1.�(.. J. ��... i.;�� �,f amu,.=iWF!,Y �{`'i�'cr, al.J.l �` 1J'sr .,�'. e-. �. tl nt. �. i'H 3.t .. 4+1, i 1 .. Y..B '�fa � t.•.� Lfeah. Plan (.'heck Niwih. Plus ('hc'c1, Iilec:. Ilan ("he=ck F_,-,, 1'ePn i! Free: 1-Voin). Pcrnzit Fe r;: Is'fec. Pe7"1rn1 Peer' O1hwr aFec•h. Insp.0 1i1F,• P ,.(mb lrvp�. Other F;G.ec. Insp.Alech. Insh. Fe 1'1111111). hisp. Fee: Llcc�. /jun. Fee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Aictrirt-otr_ L Thoco fooc mo hacod an tho nroliminary infarmatian availahlo and aro aniv an octimato_ d-nniart the ))ont far addn'l into_ FEE ITEMS (Fee Resolution 11-053 Ef : 7if 1,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $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 O Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con,'trnction /.(i1": A(ministrative Fee: O G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i 0 0 i Trcn el Doc, iane elation F(TS: Strong Motion. Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 7.d Ki»N ...,. w.l x,:.4 .,mss, "�,. d2riTsr.<,u•7ba'l,s .,.....`.. .r` _.'y.,..Md.,E.... $2.56 $236.00 z �4 t i T�oTAL F�� . ..3�.fiF„t.= ..moi.. ,.ls..>.i'1v1Ssr ,.1 T,.. 1,r. $238.56 Revised: 04/01/2015 It CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21675 REGNART RD CONTRACTOR: HIGHLIGHT SOLAR PERMIT NO: 15050067 OWNER'S NAME: OMER & YAEL GILA 3554 PARKLAND AVE DATE ISSUED: 05/12/2015 OWN R'S PHONE: 6507067461 SAN JOSE, CA 95117 PHONE NO: (408) 489-9273 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL 10 ROOF TOP, FLUSH MOUNTED PV MODULES, License Class "II Lic. # 0 3.0 Contractor o r Date 6 �/ � KW ➢ hereby affirm that I amlicensed 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. ➢ hereby affirm under penalty of perjury one of the following two declarations: 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. [ 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: 35624038.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF W_0RX IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 O IT 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 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 Issu y: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. j RE -ROOFS: Signature Date 12, 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: ➢ 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 undcr Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will ➢ 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(x) 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 Cupert' o Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2i!el 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner ► L 1 permit is issued. or authorized agent: I certify that in the performance of the work for which this permit is issued, l 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, 1 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 1 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 1K CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION .,I�'A COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION vAk 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 • buildinq(@cupertino.org PROJECT ADDRESS InC APN # C� _q O OWNER NAME e Go—�U PHOJ _ik6 E -M IL STREET ADDRESS CIC TATE, ZIP Q FAX CONTACT NAME PHONE.� r E-MAIL `i - t STREET ADDRESS L CITY, STATE, ZIP FAX S G v ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEH_, 1 ) LICENSE NUMBER LICENSE TYPE BUS. LIC # `f-, P COMPANY NAME �`C / FAX I O C, STREET ADDRESS CITY, STA E, ZIPLt PHONE i / I ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: / 0 KILOWATTS (COMMERCIAL ONLY): sl o V Li 5 TOTAL VALUATION: ` �W6 ;� D DESCRIPTION OF WORK RE ED - m=: By my signature below, I certify to each of the following; I am the property owner or authorized agent to act n property er' alf have read this application and the information I have prov' d is correct. I have read the Description of Work and verify i s accura comp with all applicable local ordinances and state laws relating to bui g construction. I authorize representatives of Cupertino to ent the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLEMENTAL INFORMATION REQUIRED " 11 OFFICE USE oNLY ` OVER,THE-COUNTER WWW Er EXPRESS qQ,.sTANDAR Td. aN ' ❑ LARGE g, ❑ MAJOR PVApp_2011.doc revised 03/16/11 Z3r, c _t 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 District. etc). These fees are based on the oreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) ADDRESS: 21675 REGNART RD DATE: 05/12/2015 REVIEWED BY: MELISSA 61ech. Permit Fee: APN: 356 24 038 BP#: 'VALUATION: 1$12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PRI SFD or Duplex USEWORK Plumb. Insp. Fee: PENTAMATION PERMIT TYPE: SOLAR -RE INSTALL 10 ROOF TOP FLUSH MOUNTED PV MODULES 3.0 kW SCOPE 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'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) Ifech. Plan C"hack Phunh, Plan Check Elec..Plan Check 61ech. Permit Fee: [Plumb. Permit Fee: bloc. Permit Fee: Other .ilech. 1nsp.Ll Other Plumb Imp. Other Stec. Insp. Wech. Insp. Fee: Plumb. Insp. Fee: Elec. Imp. 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'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: (E) Reg. 0 OT 0.0hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,4dininistrative Fee: 0 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Trcmel Documeniation Fees: Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.56 $236.00 TOTAL FEE: $238.56 Revised: 04/01/2015