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B-2016-1430 PERMIT, APP, FEE ESTCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1430 10191 HILLCREST RD CUPERTINO, CA 95014-1049 (326 16 061) ( SMART ENERGY SOLARINC) CORONA, CA 92880 DOWNER'S NAME: GOLUB SHERMAN LAND VIVIAN M TRUSTEE I IDATE ISSUED: 02/25/2016 1 4084960575 Class C-46 Lic. Date 212512016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my eense is in full force and effect. 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 die Labor Code, for die performance of the work for which this permit is issued. z. 1 have and will maintain Worker's Compensation Insurance, as provided for 4y 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 slate 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. , / Date 2/25/2016 hereby affirm that I am exempt from the Contractor's License Law for one of file dlow•ing two reasons: a. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: u 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. a 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. s. 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 tie Labor Code, 1 must forthwith comply with such provisions or this permit shot[ be deemed revoked. 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. PHONE NO: 9512739595 PERMIT INFO: BLDG X ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: ALL (N) ROOFTOP MOUNTED SOLAR PV (7.52 KW) - 23 ELS; UPCRADE (E) 100 AMP PANEL TO (N) 200 AMP PANEL Ft Floor Area: I Valuation: $35000.00 APN Number: 326 16061 PERMIT EXPIRES IF WORIC IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. PAUL O'SULLI VAN 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: Dale: 2/25/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of file 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 u- handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Day Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Healt4sissued Se Ions 25505, 25533, and 25534. )wner or authoriz_ )ate: 2/25/2016 ENDING AGENCY hereby affirm that uction lending agency for the performance if work's for which ted (Sec. 3097, Civ C.) .ender's Name Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Date 212512016 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildino(a)cuoertino.orci I�1 M PROJECT ADDRESS e1V I (�, d I -LLt S ( � ppN "3 tl. OWNER NAME �r-'O�nV j,{�(,/l 1 �6 /��r '-1 "'ONE(Log) HONE Log �y� 0�� H--MAIL STREET ADDRESS CITY, STATE, ZIP f0/9 G((L[CP--S! cR CJ Fi fu0 CV9- �tSD I FAX CONTACT NAME SS f�a} P-P—� PHO 4St 27 3 •-YS-9 S E-M.AIL EC-P1. ��s� s��sc� �r�r' _cO I STREET ADDRESS Ib l CGM Ii S% CITY, STATE, ZIP FAX 50 ❑ OWNER ❑ OWNER -BUILDER ❑ owNBRA= CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑-ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE IJ�HER 51t9�� E soy od�c� LICENSETYPE _A(� BUS. LICA /ybo6 5 COMPANY NAME AA—Q456 t £MAIL P FAX •c L— l{rT�VC J I'jJ92 NICU STREET ADDRESS f � -(( �"tit� � . 1' W-0 CITY, STATE, ZIP C®A-0� e g2-8SO PH0 a-?s ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS, LICd COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family PROJECT IN WILDLANTJ PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No SOLAR PANELS 1 ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FORSOLARPAMELS: NUMBEROFPAN'ELSfUNITS: 23 KILOWATTS(COMMERCIALONLY): �CC� V Ii �'1 ' p �+ m� JTOTAL VALUATION: Wit' 3J /1X DESCRIPTION OF WORK �t U J IO nC� N\J G �Gn-oIlL 7a,S2- E k W D 4CL P-1 r0 -r= KC) v -- `3c5 Ij a 3 2 ( A,v'�- 5 RHCEIIFc,IJH r � �.� z roperty owner or authorized agent to act on the property amer's behalf. I have read this By my signature below, I certify to each of thyisc� 'g/13v application and the information I have providd the Description ofWork and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to buildingoe representatives of Cupertino to enter the above-identifie property for inspection purposes- SignatureofApplieanUAgenk Date: SUPPLEME A FORN6ATION REQUIRED �Ytiaa A VAR TH£rC0}TI�T£R�-� ,}_�. ' PRESS T . A l-vtT'4—�nY� a� �- .: ARM43 r �8 Ba- it 01 PV.4pp_2011. do revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION iaADDRESS: 10191 HILLCREST RD DATE: 02/25/2016 REVIEWED BY: PAUL APN: 32616 061 BP#: "VALUATION: $35,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD Or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: woRK INSTALL N ROOFTOP MOUNTED SOLAR PV 7.52 K - 23 PANELS; UPGRADE E 100 AMP SCOPE PANEL TO (N) 200 AMP PANEL Elec. Plan Check 1 0.0 hrs $0.00 3lech, Perneic l ee: Plumb1(?e Elec. Permit Fee: IEPERMIT Of, idn [ Aspmu; -t vdbbs,r_ Other Elec. Insp. 0.0 hrs $48.00 Wes Iran- Fee 0'unqh 1-r-4..f cv, 1"jrc Imp I ef- NOTE: This estimate does not include fees due to other Departmernts (i.e. Planting, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are Lased on flee nrelinrinary information available and are only an estimate. Contact the Dept for athlu'l into. FEE ITEMS (Fee Resolution 11-053 E '� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $236.00 Alternative Energy System 1PHOT011RES Photovoltaic System Suppl. PC Fee: (D Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 200 amps $48.00 Electrical IBELEC200 Services Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 £"r,rzctr'tcc't rrrt 1,,=t. Administrative Fee: IADMIN $45.00 E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Pee_ $0.00 Select a Non -Residential Building or Structure G) i Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $4.55 Select an Administrative Iter Bldg_Stds Commission Fee: IBCBSC $2.00 SUB TOT ALS- $147.55 $284.001 TOTAL FEE: _ $431.55 Revls : 01/01/2016