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15090098-DP PUB23564 OAK VALLEY ROAD 15090098 ju WALKER JOHN F AND SANDRA I TRUSTEE SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23564 OAK VALLEY ROAD I CONTRACTOR: FREEDOM SOLAR INC PERMIT NO: 15090098 OWNER'S NAME: WALKER JOHN F AND SANDRA I TRUSTEE OWNER'S PHONE: 6509675297 {d LICENSED CONTRACTOR'S DECLARATION License Classy'J Lie. # } " Contractor MEOP 1 SOLAR 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: 1. 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. 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 indemnity 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 pc .Ad 'Itionally, a applicant understands and will comply with all non -point so 7 /Ce r t i per a Cupertino Municipal Code, Section 99.18. Signature / Date d ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 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: t. 1 have and will maintain a Certificate of Consent to self-insme 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. 3. 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 the Labor Code, I revoked. 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 Imes 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 165 COVENTRY CT I DATE ISSUED: 09/152015 SAN CARLOS, CA 94070 I PHONE NO: (408) 600-8791 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (N) ROOFTOP MOUNTED SOLAR- 22 PANELS (5.5 KW) Sq. Ft Floor Area: I Valuation: $30585 APN Number: 34257016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM /LAST CALLED INSP11 Issued by: �V�+^� Date• 1 v RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 255339 and 25534. . f 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.) I understand my plans shall be used as public records. Licensed CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 lei�� /%Y*'Y]Q� (408) 777-3228 • FAX (408) 777-3333 • building gncuoertino.org �/ '�(J AE PROJECT ADDRESS 23,44 04uUV( RNAD APN# �aS1,;DmF�o OWNsiNAME fYLtcVl N-— —�2/7 W�LK'tZ - SQIJo . VL STREET ADDRESS 2U'& OA c V4U&f RDq/) CITY, STATE, Cu £R7 �U CA 10 1 ¢ FAx CONTACT NAME PHONE E-MAII. STREETADDRESS CITY, STATE, aP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENr ❑ CONTRACTOR ❑ wNrmcrORAGENT ❑ AttcuniCr ❑ ENGINEER ❑ DEVELOPER TENANT CONTRACTORNAME Cg MOM„r (Yi U�CQii LICENSE NUMBER qfc, / 7� 1O LICENSE TYPE 6 %❑ BUS. LIC# 343 12 COMPANYNAME fr^ Lm BMAE. ((1•� O So FAX STREBTADDRES.S M O d Wt T L- eJN•Ip 6 tW CITY. STATE, r^ ` — PHO -b 12 -23oo ARC[RTECVENGINFERNAME LiCENSENUMBER BUS. LTC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF 24D or Duplex ❑ Multi -Family STRUCTURE : ❑ Commercial PROJECT IN WILDLAND ,�((�� URBAN IMFERFACE AREA El2 TNYes O PROJECT IN FLOODZONE ❑ Yes �O LYSOLAR PANES ❑ ELECTRICVEIRCLE CHARGING STATION 1 ❑ SOLAR WATM HEATING ❑ OTHRE: FOR SOLAR PANELS: NUMBEROFPANELSMNITS: ^� #KILOWATTS: rr� Ltj L J F TOTAL VALUATIOW sryT� 3�1 DESCRIPTION OF WORK FLW W M iKU S. -<OtAk PV IV-L LLgZILAJ RECEPADBY e 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 have read this application, and the information I have provided is correct. I have read the Descri 'on of Work and verify it is accurate. I agree to comply withal] applicable local ordinances and state laws relating to buildin. true on. I a orize representatives of Cupertino to enter the above -identified p erly for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PffK:ZUMONLY ovER-Tw�.naNrae a. } s ❑ EXPRESS :J ❑ STANDARD < ❑ THROE 1 ❑ MA.RIR PVApp_2012.doc revised 06120112 �� CITY OF CUPERTINO 11M/I FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 23564 Oak Valley Rd. DATE: 09I1512015 REVIEWED BY: PAUL APN: 342 57 016 BPf/: *VALUATION: $30,585 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK Install N rooftop mounted solar - 22 Panels 5.5 K SCOPE Alech. Plan Check Alech. Permit Fee; Other idech. Imp. hfeeh. Insp_ Fee: Plumb. Plan Check Plumb. Permir Fee: Othe-rPhuob hap. Plumb. Insp. I':. Elec. Plait Check Llee. Permit Fee: Other Klee. lisp. Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the Prelindna in ormatlon available and are only an estimate. Contact the Dept for addn7 Info. FEE ITEMS (Fee Resolution 11-053 E . 7/U13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: O Reg. ®OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construclion Tax: Administrative Fee: O G Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure Q i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $3.98 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5.98 $236.001 TOTAL FEE-,T $241.98 Revised: 07/02/2015