B-2016-1283 Permit, App, Fee EstCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1283
10159 S BLANEYAVE CUPERTINO, CA 95014-3116 (169 03 008)
(ADROITENERGY
INC)
1135 Garnet Ave #32 SAN
DIEGO, CA 92109
OWNER'SNAME: LAKE BILTMORE APARTMENTS
DATE ISSUED: 02/01/2016
OWNER'S PHONE:
PRONE No: 51OA59-4486
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Sri-& Lic. #488255
Contractor ( ADROIT ENERGY INC ) Date 2/1/2016
X BLDG —ELECT _PLUMB
—
ME CH RESIDENTIAL X 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 and that my
Beene is in full farce and effect.
JOB DESCRIPTION:
Install (24) 4' x 12" solar power roof mounted collectors for swimming pool
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
2. f have and will maintain Worker's Compensation Insurance, as provided for
h „ by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $46000.00
his permit is issued.
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
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
36903 008
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 CALLED INSPECTION.
Cade, Section 9.18.
Signets a (�G� Date 2 1 2
Issued by: 1981 ( I /
T Uw\
Date: 2/1/2016 I1.N"tS.w
OWNER -BUILDER DECLARATION -
RE -ROOFS,
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without fast obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, 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:
3. 1, as owner of the property, am exclusively contracting with licensed
Date: 2l1/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penally of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which (his permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this pooh is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code Sections 25505, 25533,. ad 25534.
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
✓/
Owner or authorized age
be deemed revoked.
Date: 2 1 2
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
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
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Signature Date 2/1/2016
Professional
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE
(408) 777-3228 • FAX (408) 777-3333 • build ina(aDcupertino.org
FIT I/ I5
183
PROJECT ADDRESS Il il/
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APN: �{y 9 30 003
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OWNERNAME jA�.P_/ '. ,�^J
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STREET ADDRESS
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❑ OWNER ❑ OUTER-BUMDER ❑ ONT'ERAGENT CONTRACTOR ❑ CONTRACTORAGENZ' ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAT<E V V/o g�L
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LICENSENUL48ER
C 'SE TYPE
BUS, LIC.
COMPANY NAMEADIZ 0-TT ewor
&MAIL
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FAX
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ETREETADDRESS
2 O Fern{ ree+
CITY STATE, Z
5c Jo,� L 5S
PHONE
ARCMTECTIENGINEER NAME
LICENSE NIMBER
BUS, LIC .
COMPANY NAME
&MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF C] SfD or Duplex ❑mMulti-Family
sTRucruRE: 6d'/Comercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA Yes ❑ No
[IEl❑
PROJECT IN
FLOOD ZONE Yes No
u SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING
STATION
SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NIIMBEROFPANELSlUNITS:
— KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION;(" da G"I
7 �y
DESCRIPTION OF WORK r2 i}u(� 1Dr^ &P
- /
h y-It 9nl or 00
x PLC_:
By my signature below, I certify to each of the following' I am the erty o\tirier or authorized agent to act on the property mw,ner's behalf. I have read this
application and the information I h pr v' ed is cc I be Tea the Description of Work and verify it is accurate, I agree to comply with all applicable local
ordinances and state laws relati to b mg Toion. I uth epresen Ives of Cupertino to enter the above -identified property for inspection purposes.
S ignature of Applicant/Ant: Date:2—E / 6
SUPPLEMENTAL INFORMATIONREQ IRED�`�`
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P K4pp_2011. doc revised 03116111
CITY OF CUPERTINO pj pw) i083
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10159 S. Blaney Ave DATE: 02/01/2016
APN:5M 03 BP#:
REVIEWED BY: PAUL
*VALUATION: $46,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in, zone? Yes •- No
PENTAMATION
PERMIT TYPE:
WORK
Install 24 4' x 12" solar power roof mounted collectors for swimming pool
SCOPE
Vech. Tian Checla
Plumb, Plan C"/rack
I'lee. P/are Check
lkck Pe raw Fee:
7 h' wb. Ferrrdt r'§;e:
241ec. PC,mit F<z.
Other Me,Hi. Plop-
O,'htr Ph?mb /nap_
t?then Eh c: insi;.El
itech Insp. 1:r.
Phnnti_ lrnsp. kra;
F„:ec b;.p_tee:
NOTE: This estimate does not include fees doe to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelinfinai information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 7111131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. 0 O'I
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
Admirtistratov fee:
0
G
Work Without Perm it? C) Yes 8 No
$0.00
Advanced Planning Fee:
$0.00
0 hours Inspections
$286.00 tSTINSP Inspection, Hourly
0
Travol j0oclgne of on Fee.%,
Strong Motion Fee: IBSEISMICO
$12.88
Select an Administrative Item
Blda Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS::
$14.881
$286,001
TOTAL F
E $300.88
Revis d: 01/01/2016