The URL can be used to link to this page

16010015 CITY OF CUPERTINO BUILDING PERMIT BUILDING_ ADDRESS: 10703 RAE LN CONTRACTOR:MOTHER NATURE PERMIT NO: 16010015 CONSTRUCTION OWNER'S NAME: LIN MARIE MEI-YI TCHENG TRUSTEE 515 WESTAIRE BLVD DATE ISSUED:01/04/2016 OWNER'S PHONE: 4085166691 MARTINEZ,CA 94553 PHONE NO:(925)212-7433 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL INSTALL 21 ROOF TOP,FLUS FI MOUNTED PV MODULES License Class Lic.# t 6'►_ / (5.88KW) Contractor Date j® 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 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 C#pensation,as provided for by Section 3700 of the Labor Code,for the Jkrformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$19933 ve 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:35607072.00 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 ORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT - T+ - 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 D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,jud costs,and expenses which ma crue against said Ci onse o granting of this permit. rt�io ally,the applic ride an and will comply sued by: Date: with all non-point s rce ulations per th uperti unicipal Code,Section 9.18.. RE-R OFS: Signatur Date All roofs shall be inspected prior to any roc mg material being installed.If a roof is installed without first obtaining an inspectii n,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 req irements under Chapter 6.95 of the California Health&Safety Code;Sectio is 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertinc 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 equ pment 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, re it Quality Ma Ment District I performance of the work for which this permit is issued. will maintain compliance with the C tino unicipal de hapter 9.12 add I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 255 5 5 ,a fIlk Section 3700 of the Labor Code,for the performance of the work for which this owner or authorized age Date: "` permit is issued. 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 ONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm at there is a construction tending 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' 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 I understand my plans shall be used as pu lic records. granting of this permit.Additionally,theapplicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �� (408)777-3228•FAX(408)777-3333•buiiding0cuaertino.ora �y PROJECT ADDRESS 10703 Rae Lane APN# 1,Wr OWNERNAME PHONE E-MAM Marie Lin 408.516-6691 STREET ADDRESS CITY,STATE,ZIP Cupertino, 10703 Rae Lane Cu ertino,CA,95014 CONTACT NAME PHONE E-MAJL Tames Plunkett 1 224-400-53 4a smichael391 mail.co STREET ADDRESS CITY,STATE,ZIP FAX 2324 Holbrook Dr Concord CA 94553 7�pn I ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR IwCONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Mark Davis LICENSE NUM548164 BER LICENSE TYPE B BUS.LIC# COMPANY NAMEFAX Mother Nature Solar E-MAS mcdl5l@yAoo.com t 4 STREET ADDRESS CITY,STATE,ZIP PHONE 2324 Holbrook Or Concord,CA 94553 925.212-7433 ARCHITECTBNGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE k USE OF N SFD Or Duplex ❑ Multi-Family PROJECT INWILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No ❑ THER: SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING { FOR SOLAR PANELS.• NUMBEROFPANELSIUNITS: 21 panels KILOWATI'S(COMM5.88 ERCIALONLY): TOT VALUATION: $19,933 DESCRIPTION OF WORK installation of 21 Solarworld SW280 PV Panels with Ennhase M250 M' oinverters.Flush mount. nze- o er's behalf. I hay ad this By my signature below,I certify to each of the following: I am the property owne work and yeti rt i:curate agree t camel all applicable local application and the information I have pro ' erect. I have read the tD for inspection u oses. ordinances and state laws relating to din struction- I authorize res Ives of o enter the ahoy Identi TAY Pe PrP Signature of Applicant/Agent PPL NTAL TION QUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER El EXPRESs ❑ STANDARD l ❑ LARGE lnMAJOR V4pp_2011.doc revised 03116/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10703 RAE LN DATE: 01/04/2016 REVIEWED BY: MELISSA APN: 356 07 072 BP#: *VALUATION: $19,933 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: A Iteration/Repair PRIMARY SFD or Duplex PENTA ATION SOLAR-RES USE: p PERMI TYPE: WORK INSTALL 21 ROOF TOP FLUSH 'MOUNTED PV MODULES 5'Mk SCOPE plum.b.;}�o,.'f"itz"£`s. '. F.. ♦ t .." Pe s 7 L .... .. 3. s _... x NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire, anitary Sewer District,School District,etc). These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (1�ee Resolution 11-053 Eff. 7/111. ) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Alternative Energy System Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $236.00 1PHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.(E) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 .Pf r�fi%%it 1:11."t?tPsr €?isf>,' - Work Without Permit? 0 Yes E) No $0.00 Select a on-Residential t'' Advanced Planning Fee: $0.00 Building or Structure Cl Strong M:otzon Fee: IBSEISMICR $2.59 Select an Administrative Item Bldjz Stds Commission Fee IBCBSC $1.00 ; SUOTAL „ $3.59 $236.00 +7AEEE . $239.59 Revised: 10/01/2015