15120059I CITY OF CUPERTINO BUILDING PERMIT I
I BUILDING ADDRESS: 10869 N WOLFS RD I CONTRACTOR: SOLARRUS CORP I PERMIT NO: 15120059 I
I OWNER'S NAME: CUPERTINO VILLAGE LP 11690 SCENIC AVE I DATE ISSUED:. 12/07/2015
I OWNER'S PHONE I COSTA MESA, CA 92626-1410 I PHONE NO: (415) 307-1737 I
Er LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 7 � 3L 5 ,y 7
Contractor & r r`v Date t Li
I hereby affirm that I am licensed un er 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
erformance ofthe work for which this permit is issued.
�I ave and will maintain Worker's Compensation Insurance, as provided for by
..tion 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 the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. dditionally, the applicant understands and will comply
with all non -point urA regulations per the Cupertino Municipal Code, Section
9.18. r 1,
JOB DESCRIPTION: RESIDENTIAL [:] , COMMERCIAL
INSTALL (1) EV CHARGER AT LEVEL 2; (2) EV CHARGERS
AT LEVEL 3 (N) DEDICATED METER (400 AMP); (N)
TRANSFORMER.
Sq. Ft Floor Area: I Valuation: $50000
I APN Number: 31605052.10869 I Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: IP°d' Date:
RE -ROOFS:
Dated 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
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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 applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
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. I 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 I 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 ertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Secj�n0550�, 25533, and 25534.
,i
Owner or authorized agent: 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
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3)28 FAX (408) 777-3333 • buildinarcDcuoertino.ora
CUPERTINO
f. 5 4 2 DCS
PROJECT ADDRESS gKid`
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OWNERNAME { l
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STREET ADDRESS / v t
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CONTACT NAN:E
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STREET ADDRESS
CITY, STATE, ZIP DW I
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VANIER ❑ 01YNER-BUILDER ❑ 0\,WER AGENT
I CON' RACTOR 0 CONI RACTOR AGENT ❑ ARC- eCT �'GIhEER � DEVrL OPER L7 EKANT
CONTRkCTORNAME wotz.
LICENSENU TLICENSE TYPE
BUS. LIC 1 1
35- P
COMPANY NA?`4E
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LICENSE NUM ER
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COMPANY NAME
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STREET ADDRESS i C
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CITY, STA E, Z.IP P O f rt
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USE OF E] SFD Or Duplex ❑ Multi -Family PROJECT IN WILDLAND,PROJECT IN
❑ YeS M4
Commercial
URBAN INTERFACE AREA ❑ Ye 1260 FLOOD ZONE
STRUCTURE;
-T -
❑ SOLAR PANELS
( ELECTRIC VEHICLE CY ARCJINC3,TATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS, XTT II'BER OF PAIvELS/UNITS:
KILOWATTS (COA4MERCI.AL ONLIO:
TOTAL VALUATION: ..,
DESCRIPTIONOF WORK
V �"dPi4
-
By my signature below, I certify to each of the follo� '
a. I am the property o��T er or authorized agent to act on the propertyyo«ner's behalf. I have d this
I agree to comply with all applicable Local
application and the information I have provided is
ct. I have re d e Description of Work and verify itis accurate
Cupertino enter the above-identified� for inspection purposes.
ordinances and state laws relating to building co ru
ion. I aut r e epresentatives of to
Date:
Signature of Applicant/Agent:
SUPPLEMENTAL RKTFORMATI N REQUEUD= of > ICsysEnN�Y
OkERTJCOURTER r
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PkApp_2011.doc revised 03/16/11
I CITY OF CUPERTINO
10MI 1PV-V lP4ZT1A4AT"R — PtIT11,DING DIVISION
ADDRESS: 10869 N Wolfe Rd
FEE
QTY/FEE
REVIEWED BY: Phuong
Plan Check Fee:
APN: 316 05 052
BP#:
EVALUATION:
fs50000
*PERMIT TYPE: Building Permit
7jLAN
CHECK TYPE: Alteration /Addition/ Repair
PRIMARY Commercial Building
USE:
1 Electrical
$179.00 1BREMPOWER Transformers
Civil / Religious activities
in 130 zone? C) Yes (E) No
PENTAMATION SOLAR -COMM
PERMIT TYPE:
WORK
Install (1) EV charger at level 2; (2) EV Chargers at level 3; (N) dedicated meter (400 amp); (N)
SCOPE
transformer.
$72.00 F40�EO amps Electrical
1BELEC1000 Services
NOTE: This estimate does not
Oz h, I , '10j"15 hvv,�
fwP0,"v:
fees due to other Departments (i.e.
Elec. Plan Check 1 0.0 1 hrs $0.00
[Elec. Permit Fee: 1EPERMIT
Other Elec. Insp.0. OTh7rs $48.00
Works, Fire, Sanitary Sewer District, School
District, etc.). piesetees are paseaon wepretiminaryinlurritulturt
FEE ITEMS (Fee Resolution] 1-053 Lff, 7,1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
3 # Alternative Energy System
$327.00 icHRGsy:4 EV Charging Station A
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1 Electrical
$179.00 1BREMPOWER Transformers
Permit Fee:
$0.00
Insp. Fee:(j) Reg. 0 OT
FSuppl. 0,0
_T_
hrs
$0.00
�
$72.00 F40�EO amps Electrical
1BELEC1000 Services
PME Unit Fee:
$0.00
$0.00
$48.00
PME Permit Fee:
Construction Tax: IBCONST,4XC
7_
$0.00
$45.00
0
G
Administrative Fee: ]ADMIN
Work Without Permit? 0 Yes (j) No$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
A
Travel Documentation Fee: ITRAVD0C OC
$48.00
$14.00
Select an Administrative Item
Strojag Motion Fee:: IBSEISMICO
Bldg Stds Commission Fee: IBCBSC
77777
$2.00
57.00
TOTAL FEE,' $735.00
o—,;aari. in/oi/2oI5
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120059
10869 N WOLFE RD (316 05 052) SOLARRUS CORP.
1690 SCENIC AVE
COSTA MESA, CA
92626-1410
OWNER'S NAME: (CUPERTINO VILLAGE LP)
OWNER'S PHONE:
LICENSED .D ONT A TOR' DECLARATION
License Class C-10 Lic. #942&1
Contractor SOLARRUS CORP. Date 02/28/2016
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:
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
�l Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICGITION
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 saidity in consequence of the granting of this permit.
Additionally, the applicg7lounderstands and will comply with all non -point
source regulatio9si2e the Cupertino Municipal Code, Section 9.18.
Date 4/5/2016
DATE ISSUED: 12/07/2015
PHONE NO: 415-845-8857
BUILDING PERMIT INFO:
—BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
INSTALL (1) EV CHARGER AT LEVEL 2 (7.2 KW); (2) EV
CHARGERS AT LEVEL 3 (14.4KW); (N) DEDICATED METER
(400 AMP); (N) TRANSFORMER - CUPERTINO VILLAGE
REV #1 - RELOCATING DISTRIBUTION PANEL - ISSUED 4/5/16
Sq. Ft Floor Area: I Valuation: $50000.00
APN Number: Occupancy Type:
31605 052
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALUD INSUCTION.
Issued by: ALEX VALLELUNGA
Date: 12/07/2015
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. 1, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed Signature of AI
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/5/2016
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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.
i. 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 must forthwith comply with such provisions or this permit shall
be deemed 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 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 applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 4/5/2416
TO BE CLASS "A"
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 or 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 I
will maintain compliance with the Cupert' o Municipal Code, Chapter 9.12 and
the Health & Safety Code, ons 25505, 25533, and 25534.
Owner or authorized agent: �&
Date: 4/5/2016 CONSTRUCTIO LF DING JENCY
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
LrA
ALTERNATIVE ENERGY PERMIT APPLICATION
CCVI✓iUNI T Y DEVELOP 1,4ENT DEPARTI✓iEN'I • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinc(c cuDertino.or
f_z
(j )2 G0L5'q
PROJECT ADDRESS O (f% I P.P\
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OWl`ERNAME MCC)
STREET ADDRESS 1 J CITY, STATE, ZIPp I FAX
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CON7ACT NAME E-? TAIL / /L
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197 co r
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STREET ADDRESS
CITY, STA. ZIP
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FPX
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CA as
❑ oNkNER ❑ OWMER-BUILDER ❑ 01AINEtAGE-Iv? CONTRACTOR ❑CON71RACTORAGi:1.'r ❑ ARCHITECT CV&GINEER 5?DEVc_L•OPER ❑ rLNAI i
CON RACTORNAT4E 4 vru LICISE ER LICENSE TYPE l
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LICENSE NUMBER Q �r
ARCHITECT/ENGr.N'EER NAME'S✓
BUS. LIC #
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COMPANY NAME
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FAX
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STREET ADDRESS
CITY, STATE, ZIP
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USE OF ❑ SFD or Duplex ❑ Multi -Family
PROJECT IN WIULAND PROJECT IN
STRUCTURE: &0 1.0m171erCial
URBAN INTERFACE AREA ❑ Yes Gr No FLOOD ZONE ❑ Yes 5'1�0
❑ SOLAR PANELS
ED -ELECTRIC VEHICLE CKARGING STATION
FE) SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR FAN'ELS. NUA!BER OF PAN'E1SA;NITS: KILOWATTS (COM> IERCI.AL ONLI�:
TOTAL VALUATION:
DESCRIPTION OF WORK r / j ! \
r--
SSvC
6V u�
17�
RECEIVE
By my signature below, I certify to each of the fol e: I am the property owner or authorized agent to act on the pr o er's be alf. I have read this
application and the information I have provi orrect 1 ave read the Description of Work and verify it is accurate. I z ee to c ply with all applicable local
ordinznces and state izws relztng to buildi . c true � u� orize representatives of Cupertino to enter the above-ideniif}ed rope-fty for purposes.
inspection
SimatumofA licant/Agent: 4A Date: L/1
SUPPMMENTAL rNF0 NATION REQUIRED
"
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PV4pp_2011.doc revised 03/16/11
4-1