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15060084CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7376 WILDFLOWER WAY CONTRACTOR: FREEDOM SOLAR INC PERMIT NO: 15060084 OWNER'S NAME: OU JUNG-HS1NG AND JENNIFER W TRUSTE 165 COVENTRY CT DATE ISSUED: 06/11/2015 OWNER'S PHONE: 4082536338 SAN CARLOS, CA 94070 PHONE NO: (408) 600-8791 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALLATION OF ROOF MOUNTED SOLAR (7 License Class Lic. # �_Z 7 MODULES)(1.89 KW). Contrac Date I hereby, affir that 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 Sq. Ft Floor Area: Valuation: $11716 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: 36619074.00 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 DAYS 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,{ granting of this permit. Add onally, the applicant understands and will comply Issued by: Date: with all non -point sour ulations per the Cupertino Municipal Code, Section 9.18. �^ RE -ROOFS: Sig tur Date All roofs shall 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. ❑ 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 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. 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(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 Cu i.no Munici al Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 55 , 25533, . d534. ` Owner or authorized agen Date permit is issued. // — —7____ 1 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 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 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(dcupertino.org PROJECT ADDRESS APN N 'J'76 13660-t'�-O�' OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, L P FAX 3� t�,��- CONTACT NAME _ Zia�� C PF ONE �`{O�S ��j-0783 E-MAIL aV"✓1� e J�zr fvl�l�t✓�c.� 1� eC:�ur-��a�..�e STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONDACTOR NAME II MZ✓ti�aZ LICENSE NUMB LICENS YPE BUS. LIC N -Frm [✓V, �. COMPANY NAME E-MAIL FAX 2 V-- STRE§ADDRESS `t . ri t Lr CIT STATE, ZIP �. 1, C� » PHONE Cr!oY 6I -D3va ARCHITECT/ENGINEER NAME LICENSE NIUM 3ER BUS. LIC N COMPANY NAME E-MA.IL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF XSFD Or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes >(Q NO FLOOD ZONE ❑ Yes ❑ NO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS(UNITS: H KILOWATTS: TOTACL,�VALUATION: 1 . /t A C✓ C.Y DESCRIPTION OF WORK l vAJ�2> �V s Fly]EDBY. By my signature below, I certify to each ollowing: 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 pr v is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatln tobuil nstrucklon. B d stat laws relating x authorize representatives of Cupertino I au to enter the above -idents led operty for inspection purposes. Signature of ll` Date: lI -20I SUPPLEMENTAL INFORMATION REQUIRED OM, CE VSE ONLY I QV -T»Cc VN1rFR d xxv SS 0, LARI-E Z 0 ? MAJOR PVApp_2012.doc revised 06/20/12 CITY OF CUPERTINO FM -K FEE ESTIMATOR - BUILDING DIVISION 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 Eff 7/1/13) ADDRESS: 7376 wildflower way DATE: 06/11/2015 REVIEWED BY: Sean APN: BP#: 0� `VALUATION: 1$11,716 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR -RES I PERMIT TYPE: WORK Installation of roof mounted solar 7 modules 1.89 k SCOPE PME Plan Check: 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 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: (j) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i./Jd t'r Il d.ft°!'bolt I:Ca: 1 O 0 Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i ,:r+ ! t;tit,cli�2r ,r ollor7 1�>,. Strom Motion Fee: IBSEISMICR $1.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS. 1 $2.52 $236.00 TQT � ' E. $238.52 Revised: 05/07/2015 t97- I m g ,LLg LLJ c5 3 22 LLJ 03 Liu r— Q r CL 0 cc u uu u 4 CSC o CL Lu C'232 ', , n �c �a- -i; cr Lu 9,4 , Lu 0 0- 0 0 Z IS chi Z LU cc C9/uz w ulT 5 o - LU rr CV07> 2§ i. 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