B-2016-1280 Permit, App & FeeCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1280
1619 JAMESTOWN DR CUPERTINO, CA 95014-5314 (366 10 100)
(SUNRUN
INSTALLAT]ON
SERVICES INC)
SAN LUIS OBISPO, CA
93401
OWNER'S NAME: TO CHIA-CHFN D AND YU TEH-HEN TRUSTEE
DATE ISSUED: 02/01/2016
OWNER'S PHONE: 408-892-4250
PHONE NO: 408-746-3062
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-46 Lie. #750184
Contractor(SUNRUN INSTALLATION SERVICES INC) Date 02/01/2016
.a BLDG _ELECT _PLUMB
MECH $ RESIDENTIAL _ COMMERCIAL
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 mild that my
license is in full force and effect.
.JOB DESCRIPTION:
INSTALL 12 ROOF TOP, FLUSH MOUNTED PV MODULES, 3.0kW
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 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.
J� z. 1 have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 or the Labor Code, for the pormminces of the work far which
Sq. Ft Floor Area:
Valuation: $6300,00
this permit is issued
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
-
Occupancy Type:
information is correct. I agree to comply with all city and county
366 10 100
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALL'a INSPECTION.
Code, Section 9.18.
t
Issued by: MELISSA NA
Signature Diate 02/01/2016
Date: 02/01/2016
OWNER -BUILDER DECLARATION
R&ROOFS:
1 hereby affirm that I am exempt Dmm file Cmutractor's License Law for one of the
All mots shall be inspected prior to any rooffiug material heing installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
following two reasons:
r. I, as owner of the properly, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant
2. 1, as owner of the property, am exclusively contracting with licensed
Date: 02/01/20I6
contractors In construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Ihereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self-insurs for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade, for the
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this pernit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
3. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
natnhtin compliance with tlue Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued.
s. Icertify that in the performance of the work for which this parent Is issued, I
material. Additionally, shard([ I use equipment or devices which craft hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worler's Compensation laws of California. If, after making this certificate of
the health & Safety Code, 25505, 255 3, and 25534.
exemption, I becmne subject to the Worker's Compensation provisions of the
,actions
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent: _
be deemed revoked.
Date: 021011201 6
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTIO LENDING ACFNCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014.3256
(408) 777-3228 • FAX (408) 777-3333 • bulldlnoCo5)Cupertlno,oro
r3 - 20/s
PROJECT ADDRESS
7'17�M1�
OWNERNAME
PHONE
E-MA1L
STREETADDRESS
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CITY, STATE, ZIP
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FAX
CONTACT NAME \�
PHONE
E MAIL
STREET ADDRESS
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CITY, STATE, ZIP
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PAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ MOMTER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Sv,�rw,
LICENSE NUMBER
LICENSE TTY,PEtt
f/
BUS. LIC9 2—/ 5COMPANY
NAME
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E-MAIL ��
FAX
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STREETADDRESS
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ARCtllTECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes @ No
FLOOD ZONE ❑ Yes [Z No
STRUCTURE:
L`LISOLAR PANELS
❑ ELECTRICVEHICLECHARGINGSTATM
❑ SOLAR WATERHEATING
❑ OTHER:
FOR SOLAR PANELS, NUMBER OF PANELS/UMTS: 1�
KILOWATTS (COMMERCIAL ONLY):
�r"�
TOTALVALUATION: (12��UO
DESCRIPTION OF WORK
-In 5 6 A-,\vA
V0r
or
By my signature below, I certify to each of the following I am the property owner or authorized agent to act of o vner's behalf. I have read this
application and the information I have provided 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 relating to building construc[io I ut rize representatives of Cupertino to enter the above -identified property for inspection purposes.
S ignature of Applicant/Agent: I
Date:
SUPPLEMENTAL INFORMATION
REQUIREDG
I�z>r-:
y
a
P i'App_2011. doe revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
jAFADDRFSS:
1619 JAMESTOWN DR
DATE: 02/0112016
REVIEWED BY: MELISSA
APN: 366 10 100
BP#: B-2016-1280
"VALUATION:
$6,300
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
INSTALL 12 ROOF TOP FLUSH MOUNTED PV MODULES 3.0 K
SCOPE
-'•AE ch. I'lon Ci;cdc 1,hu' rh. Plod CHecx f7f•c. 1'i�rn c'I�cek
Vech. 1'rr•rn_ lee_ I r rnb. t"trrnit Fee Ldfa 1'errnia l-eN �
0;&e .AkJt lrrsp. 06, Fianrr'> lnsl;- Odle, Imp,
Me :tr. Irzsp. f't Phonb, hAp. %ati; ti:R=<:. lnsp I ire:
NOTE: This estimate floes not include fees flue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
I)ichirf ntr 1. Tlrnsn fene a, hnend an thn areliminary in inrtnannn availahto and nre only an estimate Contact the Dent for aildn'I into.
FEE ITEMS (Eee Resolution 11-055 1 31
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 /i Alternative Energy System
$236.00 IPI OWTIRES Photovoltaic System A
Suppl. PC Fee: (2) Reg. ® 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
C OFi,SPi'€fCYk7l7 ��S';
iiGl?Y%7JH,Slre t11 P2('L�:
0
Work Without Permit? C) Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
I rxvelli cuinaa7 s�'� 's,
Strong Motion Fee: ISSEISMICR
$0.82
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS,
$1.82
$236.00
OTA FT
$237.82
Revised: 01/01/2016