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15090093-DP PUB1051 TUSCANY Pl. 15090093 F/P WODTKE SHIRLEY E SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1051 TUSCANY PL CONTRACTOR: FRONTIER SOLAR INC PERMIT NO: 15090093 OWNER'S NAME: WODTICE SHIRLEY E 5807 WINFIELD BLVD STE B-5 DATE ISSUED: 09/15/2015 OWNER'S PHONE: 4082520723 SAN JOSE, CA 95123 PHONE NO: (408) 927-9335 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ /�/ I/ INSTALLATION OF ROOF MOUNTED SOLAR SYSTEM (18 License Class �'� Lie. N 9 d 0 G —I MODULESX4.45 KW). v�y. •nJ A ias�P��-va�a� � LPI Llr/• Contractor .S. }L a Date) ! btI S A L I hereby affirm that I am licensed un r 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 declaratons: Sq. Ft Floor Area: Valuation: $20000 1. 1 have and will maintain a certificate of consent to self -insure for Worker's Com ensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 35929033.00 Occupancy Type: P ornance of the work for which this permit is issued. 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: a 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 peny11ditionally, the applicant understands and will comply with all non -point sot e re rfations Cupertino Municipal Code Section 9.18. RE -ROOFS: _ All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature �} /,i S 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 for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. 1, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe ode, Sections 5, 25533, and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Owner r Ruth zed age r �1 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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. Signature Dale CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (40B) 777-3333 • buildino(@cuoertino.ora ,5Z) / Ociq 3 PROTECT ADDRESS N L I APN k OWNERNAME h1 V,L -- olC� IPHONE _ \ STREET ADDRESS 0` INxl�N ejCRY,STATE,Z�1�CAA 50IF [' /_ CONTACT NAME \ 15^ �• ��ar nc,. E-MAH. ikaUii sTREET REssN`,,WI�I'I V awl,. V, ' cm, ATE, 0s6 2� F S�9al 3 ❑ OWNER ❑ M7R OWV�--7BUMD�t ❑ OWNT-RAGENT L40NTRACTOR ❑ CONIRACTORA ENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVcLOPR ❑ TENANT COC�Ojt jgL:E LICENSE TA3.1E LICEISETYP BUS. LIC R. „-'r'�C- COMPANY NNIAMMEes— I CO S ADDRESS 1 k J -Z ARCIBTECTIENGLNEER NAME LICENSENUMBER I BUS. LTC'. COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF bi( SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WB.DLAND URBAN INTERFACE AREA ❑ Yes 1K No PROTECT IN FLOODZONE ❑ Yes ❑ No SOLAR PANELS 1 ❑ ELECTRICVEMCLECKARGINGSTATION 1 ❑ SOLARWATERHEATING ❑ OTHER: FORSOLAAMA'ELS, NUMBEROFPANF.LSNNITS: I 1 KILOWATTS (COMMERCIAL ONLY): l TOTALVALUATION: DESCRIPTION OF WORK By my signature below, I certify to each of the owing: the p-pertyy owner or authorized agent to act on the property owner's behalf Ito: _ re_d :bis application and the information I have provi d is correc . I have read the_p6scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' o onntatl • g c. I authorize reses of Cupertino to enter theabove-identified propel inspection purposes. 'gnataraef-AppFiaantlhgex' - _ -. SUPPL _ NTAL INFORh4ATI0 P VApp_2011.doc revised 03116111 r�� CITY OF CUPERTINO I / I FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 1051 Tuscany PI DATE: 09/15/2015 REVIEWED BY: Sean APN: BPH: *VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES I PERMIT TYPE: WORK Installation of roof mounted solar system 18 modules 4.45 k SCOPE :leech. Plan Check Phimh. Plan Check Cleo Plan C Beck :ilech. Pertnit Yee: Phtmb. Permit Fee: Etec. Permit Fee: Other Alech, Insp. Other Plumb bup.Li I Other hlec. htsp. 1.lfech. Imp. Fee: Phtmb. Insp. Fee: flee 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 nreltminary information available and are oniv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-11 # $236.00 Alternative Energy System IPHOTOVRES I Photovoltaic System Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0_0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adminislratn e Fee: 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Plannin Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bide Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.60 $236.00 TOTAL FEE: $239.60 Revised: 07/02/2015