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15100030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22997 STANDING OAK CT CONTRACTOR:ENVER SOLAR PERMIT NO: 15100030 OWNER'S NAME: CHU JOHN W AND WOO ANN 17542 E 17TH ST STE 175 DATE ISSUED:10/05/2015 OWNER'S PHONE: 4089738280 TUSTIN,CA 92780 PHONE NO:(714)640-2340 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL INSTALL 16 ROOF TOP,FLUSH MOUNTED PV MODULES License Class Li/c.# (4.48 KW) Contractor UZC Sotiale- Date 1 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: Sq.Ft Floor Area: Valuation:$16000 �. 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 APN Number:34250021.00 Occupancy Type: performance of the work for which this permit is issued. 2. 1 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 18 ECTION. 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 y: 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 RE-ROOFS: s all non-point source regulation pe7 the Cupertino Municipal Code,Section 9.18. ! All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date 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: 9. 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 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 t. I 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 performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Owner o ho zeal 8t: Section 3700 of the Labor Code,for the performance of the work for which this Date: 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 for which this permit is issued(Sec.3097,.Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,I 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 Date ALTERNATIVE ENERGY PERMIT APPLICATION AMA COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 T ORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTI NO (408)777-3228 FAX(408)777-3333•buifdinge.cupertino.org ` _.--� 0 PROJECT ADDRESS e I APN m f/ /f r `l /j Cr OWf tRNAh4E A I PF9N E-MAIL STREETADDRESSI CITY, STATE,ZIP FAX 0 CONTACT NAME P QNE E-I,�AIL WAwreA& m m_ STRE ADDR �� CI-iY,STATE, ZIP I FAX M ❑OWh-EJt ❑ OWNER-BI)LT.DER ❑ OWNERAGENr C0117RACTOR ❑CONTRACTOR AGENT ❑ ARCHIrtCT 13 ENGENTER ❑ DEVELOPER ❑TFNANT CONT SCTORNAI AE LICENSENUI, LIC STYPE BUS.LIC R CO M NAME E-hslL FAX io _ o I � STADDRESS ( CI7Y,S r ^ZIP 1� 1 ARCHITECTIENG12\1EER NAME LICENSE NUMBER I BUS.LIC n COIdiPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND � PROJECT IN �;; STRUCTURE: F1 Commercial URBAN INTERFACE AREA ❑ Yes � iv0 FLOODZONE ❑ Yes 0111,4_0 S%DEAR PANELS TEI ELECTRIC VEHICLE CHARGING STATION ElSOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/Ui1ITS: 16' KILOWATTS(C�L�7S$RL17; (� �� TOTAL VALUATION• y�� DESCRIPTION OF WORK pve OnoI By my signature below,I certify to each of the following: I am the property owner or authorized aQe.ttfo act on the pr o«mn ' ave read this application and the information I have provided is cora I have read the Description ofrork and eriiy it is accu agree to comply with all applicable local ordinances and state laws relating to building c strut on. uthori e epresentatives of Cupertino to enter the above-identified prope ty for inspection purposes. S ignature of Applicant/Agent; - - - Date; SUPPLEMENT 1NTFORRIATION REQUIRED -F �OFk'ICE t+SE D'1S,Y _ - € 4M„_.OVFJ.2 TH)rCOUIgT'ER - -' 9M Pv4pp_2011.doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22997 STANDING OAK CT DATE: 10/05/2015 REVIEWED BY: MELISSA llmwww�lj APN: 342 50 021 BP#: 3n *VALUATION: $16,000 —� *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair USRE ARY SFD or Duplex PENTAMATION PERMIT TYPE: SOLAR-RE WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.48 k SCOPE t lecft..I'lcuz C`Iceck 11humb. Phan(7heek Elec. Plan t:itec;ic 14(,e t. Permit h'ee f'i b..11:ermit Fee: L:tec:. Peri7rit Fes. 1atf,tras`ecla-IrsP• Clider.f'(i�tub-Iizsz £lthc:r lilec�. lnsp. arch.I tsp. 1-ce: Plumb-Ir-sp. Fee; 1.,,7e•. litsp, 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 prelimina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $236.00 IPHoTovREs I Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.-(F) Reg. 0 OT 1 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiruclion Rix: Work Without Permit? 0 Yes No $0.00 Advanced Plannin.g Fee: $0.00 Select a Non-Residential E) Building or Structure O lANVI Docurnerilation 1i'ee}v Strong Motion Fee: IBSEISMICR $2.08 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 I $308 y $239.08BT2TAI$ Revised: 07/02/2015