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15060104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11056 LINDA VISTA DR CONTRACTOR:REC SOLAR,INC. PERMIT NO: 15060104 OWNER'S NAME: CONSTANT DAVID T AND TINA M 775 FIERO LN STE 200 DATE ISSUED:06/16/2015 OWNER'S PHONE: 4082553487 SAN LUIS OBISPO,CA 93401 PHONE NO:(888)657-6527 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL - r INSTALL 16 ROOF TOP,FLUSH MOUNTED PV MODULES License Class Lic.# �� '-1 (4.2KV) Contract 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8800 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 APN Number:35616025.00 Occupancy Type: 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 WITB IN 180 T 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 A ED 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 ate: 1 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. {�J RE-ROOFS: Signat� at All roofs sha 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 1 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&SafetyZCode,Sectioi 5505, ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorizet: 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 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 Code,Section Licensed Professional 9 18. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTlPIO (408)777-3228 • FAX(408)777-3333•building(cDcupertino.org PROJECT ADDRESS 11 o b( _ L t G ` 1 I APN R OWNER NAME flJ �J�\'e.�VA- PHONE &-S&2.,rj✓-2CP,4 -MAIL STREET ADDRESS (� `� CITY, STATEP G L /S7' FAX I '8 CONTACT NAMEA&44L4 ` i u/ _ ; 0 d PHO ' Lq 'WA \o. .�G �� STREET ADDRESS 2 / l+�J� `fit CITY,Ss i I' `CEJ Gl GrS{g FAX Se]h rd� 13 OWNER El OWNER-BUILDER ❑ W;NTRAGENI' 11TR CONACTOR ElCONTRACTORAGENT El ARCHITECT l❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME.'5Uvt✓`'A �A.��L�� LICENSENUMBER—..r�(�A LICENSETYP& r 'b BUS.LIC COMPANY NAME �1 'V` �-�J� ,�yL`7 ,s E-MAIL (>`� cr _i FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 9 COMPANY NAME E-MAIL, FAX STREET ADDRESS CITY,STATE,ZIP PHONE '4 USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN �l STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No NI—LAR.PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOL tR PAA'ELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): �,2 V w TOTAL VALUATI 4& DESCRIPTION OF WORK V 2 0 Yy}.fr dU `3- 'd "Ri By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro r s behalf. I have read this application and the information I have provided' correct. I have read the Description of Work and verify it isa agree to comply with all applicable local ordinances and state laws relating to building ristruction. I a i rep a tives of Cupertino to enter the a overr-ide ied prop rty for inspection purposes. Signature of Applicant/Agent: Date: S PLEMENTALINFO RM TION REQUIRED # � ��YPY30 xe ngp ��❑�OIF'F.R}TSF.COIIL\T'ER� KWVMR t �h"� a❑�` .KESS 3 a. � ,� u. �+�:_ T A[l x PT14pp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11056 LINDA VISTA DR DATE: 06/16/2015 REVIEWED BY: MELISSA APN: 356 15 025 BP#: &016) *VALUATION: 1$8,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: SOLAR-RE WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.2k SCOPE i r ,h a' x:) mk i( P,,r+ vrni3�, x"ti!tr z¢ v,s % x 1i ' .: re1 ➢ ?r�,�r X t.,_in_ i. °9. � 4, { NN, 4] ; t! t, plq ,ilech. Plan Check Phimb.Plan Check Elee.Plan Check ;b1e1/1. Permit Fee: Plumb. Permil Fee: Glen. Permit Fee: Orher rilech. Insp. other Plumb Insp. Other Elec.Insp. :i-tech.Insp. I fe: Plumb. Trap. Fee: Elec. 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 ees are based on the prelimina information available and are only an estimate Contact the Dept./or addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/13,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System Suppl.PC Fee: Q Reg. 0 OT Mhrs $0.00 $236.00 1PH0T0VRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:(E) Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: _T7 $0.00 Construction Tax.- Administrative ax:Administrative Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 O Advanced Planning Fee: $0.00 Select a Non-Residential 0 Tmwel Documenlation Fees: Building or Structure 0 i Strong Motion Fee: 1BSEISMICR $1.14 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 $2.14 $236.00 x.. _..`° r TOTAL,FEE '. $238.14 Revised: 05/07/2015