15100210CITY OF CUP ER'd INO BUILDING PERMIT
BUILDING ADDRESS: 10753 W ESTATES DR
CONTRACTOR: SANTA CRUZ WESTS IDE PERMIT NO: 15100210
ELECTRIC
OWNER'S NAME: MALIK SANJEEV AND BHUVANA
2119 DELAWARE AVE DATE ISSUED: 10/26/2015
OWNER'S PHONE: 4088356691
SANTA CRUZ, CA 95060 PHONE NO: (831) 469-8888
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
� 2,
INSTALL (N) SOLAR MOUNTED ROOFTOP PV - 19 PANELS
(5.13 KW)
License Class Lic. #
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business &c Professions
Code and that my license is in full force and effect.
Sq. Ft Floor Area:
Valuation: $17955
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
APN Number: 36923027.00
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.
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 IN 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 IN13P �']j'j[ 1\j,
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
°
/ ✓�
vim!
upon the above mentioned property for inspection purposes. (We) agree to save
Issued by: �-ate(( 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 app icant understands and will comply with
all non -point source regulations per a Cu ino Municipal Code, Section 9.18.
RE -ROOFS:
r'
All roofs shall be inspected prior to any roofing material being installed. if a roof is
Signature Date �Z/5
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
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
HA7.ARDOUS 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 &c 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 &c
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
performance of the work for which this permit is issued.
Health &c Safety Code, SectionL25105, 25533, and 25534.
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
Own au o ed nh
Date:
permit is issued.
s. 1 certify that in the performance of the work for which this permit is issued, 1 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 malting 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.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARA'T'ION
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
#1
CITY OF CUPIERTINO BUILDING PERMIT
BUILDING ADDRESS: 10753 W ESTATES DR CONTRACTOR: CI 'T-Pro Q�/
PERMIT NO: 15100210
t �iN n
OWNER'S NAME: MALIK SANJEEV AND BHUVANA
DATE ISSUED: 10/26/2015
OWNER'S PHONE: 4088356691
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL EJ
[INSTALL
(N) SOLAR MOUNTED ROOFTOP PV - 19 PANELS
License ClassLic. # ��� 0�
(5.13 KW)
��
o
Contractor Jy 1 � C�•Q�j t 6 Ctfqki�Date�
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:
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
Sq. Ft Floor Arca:
Valuation: $17955
performance of the work for which this permit is issued.
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
I APN Number: 36923027.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
�� ���� 1 ]� ISSUANCE ®�
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
YS SERO ED INSPECTION.
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
Issued
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date l t4
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
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the foflowing two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
declarations:
health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 25505, 25533, and 25534.
permit is issued.
Owner or authorized agent: Date: i
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
./`1 Tr T .f1n . �TTI . T TTTTAT,f h
+tech. flan Check
;ttech. Permit Fce:
other Wech. Insp.
V"ch_ lnsh. Fee:
MOM- This estimato
Phuxh. Plarl Check
Plumb. Permit Fee.
Other Plumb Insp.
l._'lec..Plan Check
Elec. Pem,7it Fee:
Other 1>l(Ic. Insp.
Plumb. hasp. Fee: Elec. Irur). Fee:
not include feat due to othor Donartmontc fi_o. Planninn_ Puhlic Wnrk.c_ Firo_ Sanitary .fewer Distrirt_ Vrhanl
District. etr-1 Theso feet are hated an the nrelindnary information availahle and aro only an estimate_ Contort tho Dent for addn'1 info_
FEE ITEI�[t S (Fee Resolution .11-053 Elf. 711113)
V..11 u u 4-YILI V_ �Lj 1 8JA® 8 !Ll `V `lf'
FEE ESTIMATOR - BUILDING DIVISION
JADDRESS:
10753 W Estates Dr DATE: 10/26/2015 REVIEWED BY: PAUL
N: 369 23 027
BP#:
*VALUATION: $17,955
*PERMIT TYPE: Building Permit
PIAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
Suppl. PC Fee: (D Reg. () OT0.0
PENTAMATION SOLAR -RES
USE:
$0.00
PERMIT TYPE:
WORD
Install N solar mounted rooftop PV - 19 Panels 5.13 K
SCOPE
+tech. flan Check
;ttech. Permit Fce:
other Wech. Insp.
V"ch_ lnsh. Fee:
MOM- This estimato
Phuxh. Plarl Check
Plumb. Permit Fee.
Other Plumb Insp.
l._'lec..Plan Check
Elec. Pem,7it Fee:
Other 1>l(Ic. Insp.
Plumb. hasp. Fee: Elec. Irur). Fee:
not include feat due to othor Donartmontc fi_o. Planninn_ Puhlic Wnrk.c_ Firo_ Sanitary .fewer Distrirt_ Vrhanl
District. etr-1 Theso feet are hated an the nrelindnary information availahle and aro only an estimate_ Contort tho Dent for addn'1 info_
FEE ITEI�[t S (Fee Resolution .11-053 Elf. 711113)
]FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (D Reg. () OT0.0
Lhr_s
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
COT
Q.Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conso-uction fair: C
Administrative Fee:
0
G
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Doeumentation Fees:
Strong Motion Fee:
IBSEISMICR
$2.33
Select an Administrative Item
Bldp, Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$3.33
$236.00
TOTAL FEE:
$239.33
Revised: 10/01/2015