15100220 CITY OF CUPERTINO BUIILDING PERMIT
BUILDING ADDRESS: 21862 CORTE MADERA IN CONTRACTOR:SUNLOGIC,INC
PERMIT NO:15100220
OWNER'S NAME: PERRY JEFFREY R AND CHRISTINE I 14 BETA CT 11DATE ISSUED: 10/28/2015
OWNER'S PHONE: 4082575239 SAN RAMON,�A 94583 PHONE NO:(925)939-8300
LICENSED CONTRACTOR'SDECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
VthatI
INSTALL 22 RObFTOP FLUSH MOUNTED SOLAR PANELS
License ClLic.# (7.59 KW)
ContractorDate
I hereby aed 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:$34485
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 APN Number:J2645040.00
performance of the work for which this permit is issued. Occupancy Type:
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 180 DAPS FROM LAST CALLED INSPECTION.
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 Issued by: 1J' Date:
indemnify and keep harmless the City of Cupertino against liabilities,judgments, i -
costs,and expenses which may accrue against said City in consequence of the
granting of this permi. d 'tionally,the applicant understands and will comply with
all non-point source la ons per the Cupertino Municipal Code, ectio 9. 8. j RE-ROOFS:
p All roofs shall bei inspected prior to any roofing material being installed.If a roof is
Signature Date 0 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
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OWNER-�DERDECL��TION Signature of Applicant; Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALLY ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1. 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. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 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
1. 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Health&Safety'Code,Sections 25505,25533,and 25534.
2. I have and will maintain Worker's Compensation Insurance,as provided fpr by Own r tho' z agent: /)
Section 3700 of the Labor Code,for the performance of the work for which this Date: (/
permit is issued.
3. I 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 j
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
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Signature Date
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ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1
CUPERTINO (408)777-3228•FAX(408)777-3333 buildhg-@cuPertinp org
10
PROJECTADDRES$ 2,196-2- c oy e M 6ULr APN#0
� y
OWNER NAME PHONE E-MAIL
yn� y
STREET ADDRESS ZA 1 �� tR A CITY,STATE,Z3PCU FAX
CONTACT NAME �i J
E-MAIL
STREET ADDRESSCITY,STATE z�1 f
70j Id �3Yc 51Yz � 9 � FAX
❑OWNER ❑ OWNER-BUILDER ❑OWNERAGENT CONPRAcroR ❑CONTRAcToRAGENT ❑ ARCHLTEcT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME- _ LINSEUBER (� LICENSETYPE C I O BUS.ISC0 ' '/ I
COMPANYNAME l^y,
E-MAIL FAX
STREET ADDRESS /� Y � p �\ CITY,ST TE,ZE' ;�® ® /�Z G Cf �V j PHONES1 -Cj 6
ARCHTTECT/ENGATEERNQME �UCENSE NUMBER W V` V (J� BUS.UCC#1 /
COMPANY NAME E-MAIL FAX
STREET ADDRESS MY,STATE,ZIP , PHONE
USE OF iI SFD or Dwlex ❑ Multi-Family PROJECT IN WMDLAND
"� PROIEcrIN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes; NO FLOOD ZONE ❑ Yes JR No
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SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PAIVELS.- NUMBER OF PANELSAINITS: —2, KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: 3111
DESCRIPTION OF WORK
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RECEI DY a!4z� } -
By my signature below,I certify to each of the fo g: I the property owner or authorized agent toIset on the property owner . I have read this
application and the information I have ided V' orrecrL I have read the Description of Work and verifyit is accurate. I agree to Coro—Ply With all pplieable local
ordinances and stats laws relating to tructi I orize representatives of Cupertino to-W the above-identifie-^� or 'on purposes.
Signature of Applicant/Agentc Date; l/
EMENTAL O TION REQUIRED
OFFICE USE ONLY
Q.OVE -THE-00
UNTER
❑ EXPRESS
❑ STANDARD
tttiii ® LARGE
❑: MAJOR
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PVApp 2011.doc revised 03116111
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21862 CORTE MADERA DATE: 19/28/2016 REVIEWED BY: PHUONG
,AQ
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APN: 326-45-040BP#: *VALUATIONS $34,485
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
USSIE: SFD or Duplex7 PENTAMATION
PERMIT TYPE: SOLAR-RE
WORK INSTALL 22 ROOFTOP FLUSH MOUNTED SOLAR PANELS 7.59 K
SCOPE
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NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are onlY an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 # Alternative Energy System
Suppl.PC Fee: Reg. 0 OT0.0 hrs $0.00 $236.b0 ]PHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee Reg. 0 OTF .
0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
�.t7il:if7'tiCItfJ7Z .2 C7�: f
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Administrative 1tc.e
Work Without Permit? 0 Yes No $0.00 j
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travell�(,1c''7l7}Zi:t2I.G7(it'tn Fees: �
Strong Motion.Fee: IBSEISMICR $4.48 Select an Administrative Item
Bldg Stds Commission Fee- IBCBSC $2.00
SUBTOfiAT,S: $6.48 $236.00 fitOTAL FEE; $242.48
Revised: 10/01/2015
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