15060104-pub11056 LINDA VISTA DR
15060104
F/P
CONSTANT DAVID T AND TINA M
SCANNED BOX #598
I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11056 LINDA VISTA DR I CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15060104 1
OWNER'S NAME: CONSTANT DAVID T AND TINA M 1 775 FIERO LN STE 200 1 DATE ISSUED: 06/16/2015 1
OWNER'S PHONE: 4082553487
Iq LICENSED CONTRACTOR'S DECLARATION
License Class C ;o Lic. # 7740 V84
Contract Date
1 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.
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 source regulations per the Cupertino Municipal Code, Section
9.18.
Signat/L" ate I <<►
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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.
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
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, 1 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. 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
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.
SAN LUIS OBISPO, CA 93401 I PHONE NO: (888)657-6527
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
INSTALL 16 ROOF TOP, FLUSH MOUNTED PV MODULES
(4.2KW)
Sq. Ft Floor Area: I Valuation: $8800
APN Number: 35616025.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 IT ISSUANCE OR
18 AyST-�.ED INSPECTION.
/ any
r ROOFS:
All roofs sha be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Appl
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 1 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sectioi 5505, and 25534.
Owner or authorize ent: Date:
CONSTRUCTION LENDING AGEN'CV
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinclOkupertino.oro
y
PROJECT ADDRESS , 1 /� i= � L I � 6 G Y I y ,�► '� Tom.
APN # 2 S I tLi L��
OWNERNAME /� L I, f PHONECq6o,�—'?qe�-MAIL`
STREET ADDRESS�k�``S�CITY,
STATE ZIP b � c'i / �y FAX
CONTACT NAME 1,41 i u I _ PHOT a _�p
�-fA �1
�IL� . �G
STREET ADDRESS � o
CITY, S EA P
G�'a (
FAX svh �vr�
❑ OWNER ❑ OWNER -BUILDER O'AWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINTER ❑ DEVELOPER ❑ TENANT
/❑
CONTRACTOR NAME_.5uVt ✓`' A / A �y `��
`IL{�Jr7
LICENSE NUMBER_.,r,>� zA
Y`` V
LICENSE TYPE
BUS. LIC #
COMPANY NAME ✓1'V`
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCMTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PH01'E-I��'
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT 1N
FLOOD ZONE ❑ Yes ❑ NO
LAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER DATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): dN r� V w
�i V
TOTAL V ALUATi Q h'1
DESCRIPTION OF WORK
T-3 00
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent t acf on the pro s behalf. I have read this
application and the information I have provided A correct. I have read the Description of Work and verify it is a gee to comply with all applicable local
ordinances and state laws relating to building g&struction. I a rep a fives of Ctipertino to enter the ove-ide ified prop rty for inspection purposes.
Signature of Applicant/Agent: Date:
SVISPLEMENTAL INFORM TION REQUIRED
4a�A'�Y"'
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PVApp_2011.doc revised 03116111
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11056 LINDA VISTA DR
DATE: 06/16/2015
REVIEWED BY: MELISSA
APN: 356 15 025
BP#: (�,0/D
"VALUATION: 1$8,800
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR -RE
PERMIT TYPE:
WORK
INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.2k
SCOPE
htech. Plan (,
Phunb. Plan < ,icc
Elec. Plan Ch, , k
�1ech. Permil Fec�_
Plumb, Permit Fire:
I,"",
Other lfec•h. InspE1__L_
Other Plumb InspLl
Other Elec. Insp.
!"(17 Invi. Fe(.
Plumb. Insp. Fce
F;lec. Insp. Fe°e
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
11 #
$236.00
Alternative Energy System
IPHOTOVRES I Photovoltaic System
Suppl. PC Fee: Q Reg. () OTT
0.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
Q OT 1
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
'olz.SIrllcfion ToY:
1chninistrative Fees
0
Work Without Permit? Yes E) No
$0.00
Advanced Plannin Fee:
$0.00
Select a Non -Residential
Building or Structure
7i•crr._'' I>r,cunzc�filczlrrr .1�cr>_,
Strong Motion Fee:
IBSEISMICR
$1.14
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.14
$236.00
TOTAL FEE:
1 $238.14
Revised: 05/07/2015