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15090147CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS. 10501 FLORENCE DR CONTRACTOR: SKYWAY ELECTRIC PERMIT NO: 15090147 OWNER'S NAME: ESCHELBECK GERHARD AND ELISABETH TR I I I N MARKET ST STE 300 DATE ISSUED: 09/22/2015 OWNER'S PHONE: 4983154875 SAN JOSE, CA 95113 PHONE NO: (408) 797-7419 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL 18 ROOF TOP, FLUSH MOUNTED PV MODULES G License Classr—l()1 Lic. # (� 7 ! 5 (9.6KW) Contractor 1 7'\� t"I p �I Date 5/z2//s 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. Sq. Ft Floor Area: Valuation: $19000 I hereby affirm under penalty of perjury one of the following two declarations: t. 1 have and will maintain a certificate of consent to self -insure for Worker's APN Number: 32635038.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. z. 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. 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 FR LED INSPEC ION. 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 y/ upon the above mentioned property for inspection purposes. (We) agree to save Date: 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 ROOFS: all non -point so ce regulations r the Cupertino Municipal Code, Section 9.18. Signature / V `' �� Date PW All roofs shall be inspected prior to anyy 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 Applicant: Date: ❑ OWNED- BUILDER DECLARATION I hereby affirm that I ant exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reason: t. I, as owner of the propOrty, or my employees with wages as their sole compensation, will do dhe 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 z. I, as owner of the prop$rty, 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 1 use equipment or devices which emit hazardous air t. 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 & Safety Code, Sections 25505, 25533, and 25534. performance of the wotk for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by Ow r authori a nt Section 3700 of the Labor Code, for the performance of the work for which this Date: f permit is issued. 3. 1 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 1 have read this application and state that the above information is I understand my plans shall be used as public records. correct. 1 agree to complyi 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 Date CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt. etr_)_ I Those fees aro hosed an the nreliminary information available and are nnly an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution II -053 Eff 711113) ADDRESS: 10501 FLORENCE DR DATE: 09/22/2015 REVIEWED BY: MELISSA 10 AVN: 326 35 038 BP#: EVALUATION: 1$19,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION SOLAR -RES PERMIT TYPE: WORK IN4f TALL 18 ROOF TOP FLUSH MOUNTED PV MODULES 9.6k SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt. etr_)_ I Those fees aro hosed an the nreliminary information available and are nnly an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution II -053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 7-1-1 # $236.00 Alternative Energy System IPHoTovREs Photovoltaic System Suppl. PC Fee: (j) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit?Yes No $0.00 Advanced PI Rnning Fee: $0.00 Select a Non -Residential Building or Structure i I:,e=,>rt=itir:>t'�iliarl ; z.� Strom; Motion Fee: IBSEISMICR $2.47 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.47 $236.00 TOTAL FEE: $239.47 Revised: 07/02/2015 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDrupertinp M V �— PROJECT ADDRESS 4APN # OWNER N E STREET ADDRESS p CITY, STATE, P� �., FAX C(VA' 'NAME 1 ,1 k PHONg / J �-7Dl_ STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR t9 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMt LICENSE NUMBER,, iz'3 LICENSE TYPE C j0 BUS. LIC # COMP Y NAME _ E-MAIL FAX STREET ADDRESS CTTY, STATE ZIP 5G PRONE ARCHrrECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ❑ Multi -Family STRUCTURE: []:Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes NO PROJECT IN FLOOD ZONE ❑ Yes W9-0 I�AR PANELS' ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEA���Ttttl►►►NG -:�?T ❑ OTHER: FOR SOLAR PANELVq NUMBER OF PANELSIUNITS: 1 KILOWATTS (COMMERCIAL ONLY):. L/J , TOTAL VALUAT!Z DESCRIPTION OF WORK PV C, C Qo /lgc'ti C,4 --W By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to on the property o e f I have read this application and the information I have provided is correct. I h ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ding construction. orize representatives of Cupertino to enter the abov ident led(( property for inspection purposes. 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