15080153L.091
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1182 STAFFORD DR
CONTRACTOR: SUN INCORPORATED
PERMIT NO: 15080153
OWNER'S NAME:
MODESTO, CA 95354
PHONE NO: (209) 575-5997
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F]
INSTALL (N) ROOFTOP MOUNTED SOLAR PV - 19 PANELS
License Class �' /V Lic. # `1C^1 l c
(5.13 KV) AND INSTALL (N) 100 AMP SUBPANEL
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Contractor -:97 Date,/3
I hereby affirm that I am licensedun er 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: $15400
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: 36211022.00
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
WITHIN 180 DAYS OF PERMIT 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 D>VS FROM LAST CALLED 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
/ " Date:
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.
! -- /
RE -ROOFS:
Signatur /% > Date_�
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)
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 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 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' and 2 534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: �� Date
/!%� /i
permit is issued.
y44
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
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
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
�� CITY OF CUPERTINO 1 0 3
-W
IY FEE ESTIMATOR - BUILDING DIVISION
... rt e. r ...
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Mctri�t oto 1 Thoco fooc aro hacod nn tho nroliminani infnrmatinn availahla and aro anhi nn octirnnto_ rnntart tho Dont fnr addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Ef' 7./1/13,)
ADDRESS: 1182 Stafford Dr
DATE: 08/20/2015
REVIEWED BY: PAUL
APN: 36211022
BP#:
*VALUATION: 1$15,400
-`PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
SFD or Duplex
FO.OThrs
PENTAMATION
SOLAR -RE A
USE:
PME Plan Check:
PERMIT TYPE:
WORKInstall
N rooftopmounted solar PV - 19 Panels 5.13 K and Install N 100 Am Subpanel
SCOPE
Permit Fee:
... rt e. r ...
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Mctri�t oto 1 Thoco fooc aro hacod nn tho nroliminani infnrmatinn availahla and aro anhi nn octirnnto_ rnntart tho Dont fnr addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Ef' 7./1/13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
/r
Suppl. PC Fee: (F) Reg. () OT
FO.OThrs
$0.00
PME Plan Check:
$0.00
100 amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong; Motion Fee: IBSEISMICR
$2.00
,
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$144.00
$284.00
TOTAL FEE:
$428.00
Revised: 07/02/2015