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I CITY OF CUPERTINO BUILDING PERMIT I
BU➢LDING ADDRESS: 20183 SOMERSET DR I CONTRACTOR: SOLAR WINDS PERMIT NO: 15040155
OWNER'S NAME: SCHARF STEVEN M AND CHIU KAREN K
OWNER'S PHONE: 4082027910
❑ LICENSED CONTRACTOR'S DECLARATION
License Class ,°! 0 Lic. 8'3J_/ 4
Contractor Date !Y-2
➢ hereby affirm that I am licensed 14.1r 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:
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 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 relations per the C�t(iertino Municipal Code, Section
9.18. 7z � / A
Signature,�g _ �� Date 9V 2�
❑ OWNER -BUILDER DECLARATION
➢ hereby affirm that I 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
➢ 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, I 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. 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.
1717 SOLANO WAY STE 11 I DATE ISSUED: 04/21/2015
CONCORD, CA 94520 1 PHONE NO: (925) 685-1565
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
INSTALLATION OF A ROOF MOUNTED SOLAR (16
MODULES)
(5.4KW); ELEC PANEL UPGRADE (200 AMP); INSTALL 100
AMP SUBPANEL.
Sq. Ft Floor Area: I Valuation: $25000
APN Number: 36930009.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: �/1/ f%'G Date:
RE -ROOFS:
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.
Signature of Applicant: 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. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I 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 I
will maintain compliance with the Cupertino Municipal Co Chapter 9.12 and
the Health & Safety Code, Sections 25505,1001 and 2,
Owner or authorized agent: Date:'9:�:2_/�
CONSTRUCTION LENDING AGENCY
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
Signature Date
j�o�o�s5
C UPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building Qcupertino.orq
AE
PROJECT ADDRESS � O 193 'j
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OWNERNAME
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APN # �% /�% D /}
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
C CTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
C9MP NY NAME
E-MAIL
FAX
STREET ADDRESS
S i'l
CITY, STATE, ZIP
PHONE
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ARCHITECT/ENGINEERNRME
LICENSE NUMBER
BUS. LIC #
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 0
PROJECTIN
FLOOD ZONE El Yes NO
❑ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER DATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OFPANELS/UNITS: & �KILOWATTS (Cl�4bf� " RRR•9?i�,'I'):
�s
TOTAL VALUATION:
2
DESCRIPTION OF WORK F
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S
e
RECEIVEDBY
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relay o '[ding construction. a orizerresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agen. Date:^,/�%S"
SUPPLE14ENTAL INFOKMATION
REQUIRED
OFFICRUSE ONLY
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OVER ,Tg&,COUNTER
❑ EXPRESS
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❑ STANDARD
❑ LARGE
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P VApp_201 1. doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
20183 Somerset Dr
DATE: 04/21/2015
REVIEWED BY: Sean
APN:
BP#: s S
'VALUATION: $25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
Installation of a roof mounted solar 16 modules 5.4k ; Elec panel upgrade 200 amp); install 100
SCOPE
amp subpanel.
tlech. Plan Cluck
Plrurrh. Plan Check
Elec. Plan Check 0.0 1 hrs $0.00
Llech. Permit Fee:
Plumb. Permit Fee:
Elec. Permit Fee: IEPERMIT
Other ;1/erh. Insp. L]
Other Plumb Inslr_Li
Other Elea Insp. 0.0 hrs $48.00
Adech. Insp. Fee:
I'/trnrh. Insp. 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 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 lff 711113)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.00
Alternative Energy System
/PHOTOVRES Photovoltaic System
Suppl. PC Fee: E) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
E2Kl amps
$48.00
Electrical
1 IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0 0 hrs
$0.00
= amps Electrical
$48.00 IBELEC200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tax: L�
Administrative Fee: IADMIN
$45.00
E)
Work Without Permit? 0 Yes i& No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$3.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$145.25
$332.00
TOTAL FEE:
1 $477.25
Revised: 04101112015
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