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15070176-D£99# XOG a3 N NV:)S >I f1S1 bib nvi v 80b d/3 9LZOLOSI ba b31X3a ti8£ZZ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21384 DEXTER DR CONTRACTOR: SANTA CRUZ WESTSIDE PERMIT NO: 15070176 ELECTRIC OWNER'S NAME: ROB & LAURA TSUK 2119 DELAWARE AVE DATE ISSUED: 07/242015 OWNER'S PHONE: 4088354218 SANTA CRUZ, CA 95060 PHONE NO: (831) 469-8888 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ((�� S INSTALL NEW SOLAR PV MOUNTED - 29 MODULES License Class C— l 0 Li,. N • — (7.25KW) ,i2Xba ���{ Contractorl/ I hYC-_rTCr�PeGDate Z 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 fall 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 One Sq. Ft Floor Area: Valuation: $25375 performance of the work for which this permit is issued. 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 APN Number: 32641068.00 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 fALLED INSPE TI N. 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 Issued by: Date: with all non -point source regula[i as per he Cupertino Municipal Code, Section 9.18. lioeRE-ROOFS: Signature Date Z'•` �.% 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law forone of lire following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the properly, 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 requirements under Chapter 6.95 of tine California Health & Safety Code, Sections 25505, 25533, and 25534. twill 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(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 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 Cupertino Municip Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the health & Safety Code, Sections 25505, 255 f3, and 5534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent 'C 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 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 (his permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all oily 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 indemnity and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I 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 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21384 DEXTER DR I CONTRACTOR: SANTA CRUZ WESTSIDE I PERMIT NO: 15070176 OWNER'S NAME: ROB & LAURA TSUK OWNER'S PHONE: 4088354218 1 a LICENSED CONTRACTOR'S DECLARATION License Class �� �'V Lic. it 2 Contractor Date 1 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: t. 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. 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 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 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 die 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 regulation per tl Cupertino Municipal Code Sect It9.18. pA > Signature Date V /3 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penally of perjury one of the following three declarations: t. 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 Cade, for the performance of the work for which this permit is issued. 2. 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 permit is issued. 3. 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 became 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 the Labor Cade, I must forthwith comply with such provisions or this permit shall be deemed revolted. 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 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 applicard understands and will comply with all non -point source regulations per die Cupertino Municipal Code, Section 9.1 S. 2119 DELAWARE AVE (DATE ISSUED: 07/24/2015 SANTA CRUZ, CA 95060 1 PHONE NO: (831) 469-8888 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ MSTALL NEW SOLAR PV MOUNTED - 29 MODULES (7.25KW) Revision #1 - Revise Electrical Detail's on Sheet PV 3.0-ISSUED 10/14/2015 Sq. Ft Floor Area: I Valuation: $25375 APN Number: 32641068.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D S `FIROMf /LAS�Tey CALLED IN`SPECTIIO%N. Issued by: CU' 'U L(i " ` Date: {® 1 d�rl i 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the 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 at, handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Onga or ou nor'. d a n _— W /S Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Date ALTERNATIVE ENERGY PERMIT APPLICATION Lm COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AE CUPERTINQ (408) 777.3228 •FAX (408) 777-3333 • buildin ru ertinO.O o��9. PItOII!0 ADDRESS APN N OWNER NAM[ PHO E-MAII, Or SI'RFETADDRESS 21 rr 3 ' CITY, STA ZU �i FAX CONTACT NAME PITON L vt GMAII., J o 0 Ef C arltr-rf ADDRESS CITY, ST TF 'l.IP PA' ❑OWNER ❑OWNCR-BUILDER ❑ounsull AGENT CONTRACCON ❑ CONRACTORAGMT ❑ ARCHDECT ❑CNOINF.ER ❑ DEVELOPER ❑'1'NNANI' CON'I'R:?l;l'OR - .AMh'. .ICF.NSE NUhfOGI LICCNSC TYPE Bills LTC,a 1' COMPANY NAME EMAIL FA' STREF'I'A0DR1"1 Z(Cl LI'I'Y, ETA7 L, ZIP C PHONE / nyA to ARCI lFeECT/CNGINEFR NAME LICENSE NOMDER DOS. Lie E COMPANYNAME � ` E-MAIL FAX C j L STIIEEr ADDkh'_$5 /' / ` ('1'rY, STATE, 21P��t� I/% V ,NONE l / TINE of /K SFD of Duplex ElMulti-FR Wmily PROIECI' IN ILDLAND PROJECT IN S'IRUCIURE: ❑ Commercial URBAN INTERFACHAReA ❑ Yes ❑ No FLODDZONE ❑ Yes ❑ No 'OLARPANELS ❑ ELECTRICVEHICLE CHARGING STATION ❑ SOLARIVA'CERHISAIING ❑ OTHER: _ FORSOI.AHP,IKELS: NUMBER01 P:ANEI,91UNITS. KILOIVAI'TS (C(JMAIERCIAL (7NLY): 'r0'I'AL VALVATION: DES('UP'l ION OF WORK �' L fAq Y _—--.-.... I REcCrvrDBYcps r x jV/• VV � lay my xignatule below, I certifv to each orth allowing: I am the properly mvner of authorized agent to act on the pruparly owner's behalf. l have read this application and the iDlbnnation I have now ed is correct. I have read the Description or Work and verify it is Rccumte. I agree to comply with all applicable local ordinances and state laws relating to b nstr Ic ie . I aulborirc represemRlives of Cupertino to enlcr the above -identified properly Car inspection purposes. Signature ol'Applicanl/AgenC SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVRR•TIIR-COUNTER o- ';: ❑ EXPRESS ,�'rt+' 'y STANDARD V El 0 I.AR(:B ❑ MAJOR PI,App 201 Ldoc r¢vised 03QGf11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(WcuUertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT PROJECT ADDRESS APN : Iq O / OV1N'ERNAME � � U p� l P 1JIE� E-14AILLL 'STREET ADDRESS ^ ,5_ / / p - CITY, ST(fATE, Z[ v r. MU R � pL 611 FAX C9A/R/!/-GE a 4zo Z l't�lG� 1 x5 .-Lei PIL HO 3 J EM C � H/ - A[✓��� STREET D S E CTTY, STA E, Zip G n U,37 aG 5G-12G F J� ❑ OPMER R OWNER -BUILDER ❑ ORTcRAGENr CONTRACTOR ❑ CONIRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER �{ LICENSETYPE n yi (,/ �/ BUS. LICK CO /JNY NAME (DRESS B."L F r /iJ� STREET 2 ( � � CITY, STATE, ZI� ' P7U ��S, `%\ I/ / "' "1 / ARCHITECT/ENGINEERNA-ME LICENSBNUMBER BUS. LICk COMPANY NAME E-MAIL FAX STREET ADDRESS CTFY, STATE, ZIP PHONE DESCRIPTION OF WORK e77\. � gWL4L4 Q p A-77"4 I 11 n *„� -�'G EXISTING USE PROPOSED USE CONSTRTYPB ASTORIES I USE TYPE OCC. SQ.FT. I VALUATION(S) EDOSTG NEW FLOOR DEMO TOTAL. AREA AREA AREA NETAREA -- BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA - PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ AT ACH RDWELLiNGUNITS: ISASECONDUNrP ❑YES SECONDSTORY E)YFS "— BEING ADDED? ENO ADDITION? ENO PREAPPLICATION []YTS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES -SIVE7]$Y ` _ — -= TOTAL ION; PLANNINGAPPL. ENO PLANNsINCAPPROVALLETTER EiCHLERHOME? ENO ---- By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I hav read this application and the information I have provided is cc, I hav Cad the Description of Work and verify it is accurate. I agree tocomply with all applicable local ordinances and state laws relatingk ing cyq�struc . I epresentadves of Cupertino to enter the above-ide Ified pro try for i ection purposes. �d Signature of Applicant/Agent: .y*�P Date: SUPPLEMENTAL INPORIvvIATION REQUIRED New SFD or A4ultlfantily dvvellings: Apply for demolition permit for ,pox�a><coN�rRR DACYLANRDVIESY� mit existing building(s). Demolition peris required prior to issuance of building -.� L�' axexes —� permit for new building. r©P"�i,.,vl.-v.c-rLnn RRvvEKy_ L7tIBoRrc. _Commercial Bldgs Provide acompleted Hazardous Materials Discloswe-.van. : form if any Hazardous Materials are being used as part of this project �"�—- _ Copy of Plamring Approval Letter or Meeting with Planning prior to C'iTASORANITi]'A_SER�RZIS7'pIIC��_ submittal of Building Permit application. e 0A Bldgdpp. 2011.doc revised 06121111 15M 6 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 21384 Dexter Drive DATE: 07/24/2015 REVIEWED BY: Paul APN: 326 41 068 BP#: `VALUATION: $25,375 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: p PENTAMATION PERMIT TYPE: SOLAR -RE WORK Install new PV solar mounted - 29 Modules 7.25K SCOPE Meth. Plan Check Plumb. Plan Check P.1etc. Plan ("heck Mech. Perwii Fee' Plurnh. Permit Fee: lilac. Permit Fee: Other,1-tech. Imp. Other Plumb Insp Other Elce. Insp. 1,12ech. Insp_ lee: 1,11n'ub. Insp. Meer Elec. Imp, Fee.' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prefiminar information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7/1/13Z FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236,00 Alternative Energy System 1PHOTOVREs I Photovoltaic System Suppl. PC Fee: Q Reg. © UT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cpnstraction Tax: Administrative Fee: 0 0 Work Without Permit? 0 Yes i@ No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G A Travel Documentation Fees: Strong Motion Fee: IBSEMWICR $3.30 Select an Administrative Item Bldg Stds Commission ,Fee: IBCBSC $2.00 SUBTOTALS: $5.30 $236.00 - TOTAL :;, $241.30 Revised: 07/02/2015 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21384 Dexter Drive DATE: 10/14/2015 APN: 326 41 068 BP#: REVIEWED BY: PAUL "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #1 - Revise Electrical Detail's on Sheet PV 3.0 SCOPE 'Vech, plan Check Plvaob. Plan (. heck Alec. Plan Check kieeh. Permit Fee: 1'h4mb. Permit Fee: /;lac. Permit Fee' Other-;t4ech. fnsp. Other plumb Insp. OtherEle, c. Insp, 1/ech. Insp_ hee: P'hmrb. hap. 1%ee: We(. Insp, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are anly an estimate. Cnmart the Dons Far adda'1 ;a Fa. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? (:) Yes G) No $0.00 0 hours Plan Check, Hourly $143,001 ISTPLNCK Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. () OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Trm,el Docionentation Fees: Stl'Ong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 77777 SUBTOTALS! $0.001 $143.00 TOTALFEE: $143.00 Revised: 10/01/2015