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15080078 -DP10951 SANTA TERESA DR 15080078 F/P DAWOOD ASHRAF AND NAYYARA SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10951 SANTA TERESA DR CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15080078 OWNER'S NAME: DAWOOD ASHRAF AND NAYYARA 775 FIERO IN STE 200 DATE ISSUED: 08/10/2015 OWNER'S PHONE: 4082526475 SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ r" License � `7 5DL S � INSTALL ROOF TOP, FLUSH MOUNTED 22 PV MODULES Class G Lie. N (5.72 KW) & REPLACE (E) 200 AMP PANEL (SAME a I LOCATION) Contrac Date I hereby affirm that 1 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 Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $12000 erformance 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 permit is issued. ApN Number: 35615009.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of This city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR SPECTION. indemnify and keep ha mless 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 sue Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. d ' OFSOFS: Signa Date f- (S All roofs shall bed cP r to anri6 y roofing material being installed. If a roof is installed without hrsf—fobtaining an inspection, I agree to remove all new materials for ElOWNER-BUILDERDECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of : Signature of ApplicantDate: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should 1 store or handle hazardous 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 O5, 25533 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner 0 WA' permit is issued. or authorized t: Date: 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 concoction lending agency for the performance of f_o_rthwith comply with yc ich_prnvisions or this pemhitshall-be- deemed -revoked. -' s-fouvhichthis _pemyit LissimA.(Se"097, Civ C.) Lender's Name Lender's Address 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, 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. graining 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 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION11 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org /�O /t7�E PROJECT ADDRESS lU + S�^ G� \ " APNa / f / _ I) O 0c, VJ OWNERNAME _I �]J1 ✓yr`� �AX uZz6 PHONE i/�iGb... L -MAR. STREETADDRESS 1 �`-- \e� CTFY. STATE, ZIP`( FAX CONTACT NAME -VMa (`Y., STREETADDRESS Crn. STATE, Z@ FAX FY4rt4A •cow•. ❑ OWNER ❑ OWNER-BLADER ❑ OWNER AGENT ❑ CONDUCTOR ❑CONTRACrORAGENf ❑ ARMUMCT ❑ENGINEER ❑ DEV61pPER ❑ TENANT CONTRACTORNAME �• LICENSE NUMBER LICENSEBUS. LIca COMPANYNAME JVr1%� ■V�71 I — gy�'��10h .L�a�.(�X STAEETADDRESS ,29ol 2--a\k �/✓-A QTY. STATE,W JVAC UPA f"7vlJ LU HC7 �! K e oo� L�'`l ARCHMECTRNGIJEER NAME LICENSE NUMBER S. 11 a COMPANY NAME E MAR' X A STREET'ADDRESS CITY. STATE. ZIP ONE USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT DI WI DLAND CT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ ZONE ❑ Yes ❑ No TRLRPANELS ❑ ELECIRICVEHICLECHARGINGSTATION ❑ SOLAR WATER HEATING RSOLARPANELS.- NUMBEROFPANELVUNITS: XII.OWATTS tCOMMERCIAL ONLY): TOTAL VALUATION: Zy0 O DESCA@TION OF WORK By my signature below, I certify to each of the following: I am the property owner or authorized agent to act application and the information I have provided is orrect I have read the Description of Work and veri it is accur�t� I �� read this ordinances and state laws relating to building co tocomplyall local I 'u ction. representatives of CLpertino m enter the aD c-id ti5ee for'nswtioh n purposes. Signature of ApplicandAgent. �Z` purposes. Data: Ji—FORMATION REQUIRED P1'4PP 201-1.docrevised03116111 CITY OF CUPERTINO I //I FEE ESTIMATOR - R1I11.D11N _ nlvrcrnN ADDRESS: 10961 SANTA TERESA CR DATE: 08/10/2015 V REVIEWED BY: MELISSA Mi APN: 35615009 BP#: Q 'VALUATION: $12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: SOLAR-RES WORK INSTALL ROOF TOP FLUSH MOUNTED 22 PV MODULES 5.72 k & REPLACE E 200 AMP SCOPE PANEL (SAME LOCATION) Elec. Plan Check 0.0 hrs $0.00 fermi[ Fbe: Plum Elec. Permit Fee: IEPERM/T udm, ; k, is b ,l' Other Plumb Inap. Other Elea Insp. 0.0 hrs $48.00 1-lech. Insp. Pee .- Plrnuh. hasp. Fee: Elec. Insp. h'ee: NOTE. Th' is estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nrolimina information available and l FEE ITEMS (Fee Resolution 11-053Xff 7111131 FEE are QTY/FEE on an estimate. Contact the De t or addn l info. MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System IPllozovREs Photovoltaic System Suppl. PC Fee: 0 Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps $48.00 Electrical immc200 Services Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. © OT 0.0 �s $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 aruction Tay: Administrative -Fee:- IADMj,V $45:00 - - - 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Plannine Fee: $0.00 Select a Non -Residential Building or Structure Q Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $143.56 $284.001 TOTAL FEE: $427.56 Revised: 07/O2/2015