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Permit Information
Permit Number'
09110132
Status'
C - Closed
w
Master Number
L
�C
Notes
Project
Apply Date'
11 /23/2009
Operator
�patg
Permit Issue Date
12/15/2009
Operator
(petg
Certificate Issued
12/21 /2009
Operator
PALM
Certificate Type
Certificate Number
Permit' Property I� Zoning II Applicant ! Contractor Defined Fields
Permit Details
Permit Type' !SOLAR-RES�
Location Information
Address " 22067 CAROLINE DR
City/State/Zip CU PE R T I N O
APN 32603016.00
Unit
0 :•:net E ntity I ntorrration
Owner Name' MOIRAAND BRENDAN DELUMPA —�
Use Default
Address Home - 22067 CAROLINE DR v
City/State/Zip
RESIDENTIAL SOLAR PANEL
Usage Class '
NIA U
[NON APPLICABLE
Applied Value '
L_—_ 38000
SQUARE FT.
Calculated Value
O
US C-404 Type
ALT: RESIDENTIAL
Permit Form
JAUTOPEFIM PERMIT �►j
Ownership
1 - Private,
Project Size
STANDARD STANDARD
Enter the purpose or any special conditions for this permit
CA 95014
CUPERTINO CA CA 95014.0106
Purpose/Special Conditions — --- --- — - - — —
INSTALL PV SOLAR ELECTRIC SYSTEM 30 MODULES 6
IKILOWATS
FILMED- 20111
A
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�OK
Back
Ln Contractors
Fees
Plan Reviews
Inspections
Print Permit
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l Holds
Copy Permit
lr Close Permit
Overrides
S upplemental Fields
1� -3 Notes
01 Attachments 1
CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 22067 CAROLINE DR I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 09110132 1
I OWNER'S NAME: MOIRA AND BRENDAN DELUMPA I I DATE ISSUED: 12/15/2009 1
OWNER'S PHONE: 4087335881 1, 1 PHONE NO:
1P LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. # 1 a b 6C� a
l'
Contractor Bay Ae-6 � S-),v 'Date 12 11 (�J
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:
1 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.
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above information is
correct. 1 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) o 7
❑ OWNER -BUILDER DECLARATION
1 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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.
1 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, 1
become subject to the Worker's Compensation provisions ofthe Labor Code, 1 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
BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB I—
MECH r RESIDENTIAL F COMMERCIAL F
JOB DESCRIPTION: INSTALL PV SOLAR ELECTRIC SYSTEM 30 MODULES 6
KILOWATS
Sq. Ft Floor Area: I Valuation: $38000
APN Number: 32603016.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: _ Date�/2--/�-41C
RE -ROOFS:
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.
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 Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: l
Date: Z l L I n
CONSTRUCTION LENDING AGENCY
1 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 Professiona
CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10212 N DE ANZA BLVD I CONSTRUCTION BENCHMARK I PERMIT NO: 09060054
I OWNER'S NAME: 10212 N DE ANZA LLC 11045 LINDA VISTA AVE I DATE ISSUED: 11/02/2009 1
OWNER'S PHONE: 4086SS2326 MOUNTAIN VIEW, CA 94043 1 PHONE NO: (650) 938-1802
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG i— ELECT r PLUMB i—
License Class Lie. #
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 & 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:
1 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.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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.
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: COMMERCIAL T.1. INCLUDES STRUCTURAL,
ELECTRICAL,
MECHANICAL, & PLUMBING 2,864'.
11/04/2009 REVISION 41- REVISED TRUSS CALCS(SEE
Sq. Ft Floor Area: I Valuation: S450000
APN Number: 31626088.01 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Date I Issued by<_� Date: %2'7r�r
h: 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)
1, 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, 1 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 hannless 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 /T,1l 1 k, 11)4A,7W U t� Date
RE -ROOFS:
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.
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 Cupertino Municipal Code, Chapter 9.12 and the
Health & afety Code, Sections 25505, 25533, and 25534.
O r z gent:
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
�I(ol3.�z
CITY OF CUPERTINO
SOLAR PANEL
PERMIT APPLICATION FORM
CUPERTINO
APN#��`P� �Ql
Date:
I1' l o�
I
Building Address:
oZoZv(o�- Cl�12O L Iti/� �% CUiJE�T �"'a C�-
Owner's Name:
E LvM pl1
Phone #:
1/09 - �33 — 599�
Contractor: Phone #: 51 a -d13- 03
Contractor License #:
(a ovlS Fax#: ,a-g _o3Sb
`ld 965J-
Contact: Phone #: ,may �-71 _ o }o �
Zo 6 eA t3
Cupertino Business License #:
Fax #: 51 b- d C1 3 _03 -6
Job Description:
rr 1 l
Z R S r-t I l • V ' S J+ 1✓ E le c- -1Y, c_ S S+-C�.— 13 0 rh o oru es
Residential 14 Commercial ❑ Number of Panels/Units: 3 p Kilowatts: 6 /c
Valuation (cost ofproject): 3 8/ ca o --
Project Size: Express Standard _ Large Major
Green Points:
1.2 KW — 6 Points ❑ 2.4 KW —12 Points ❑ 3.6 KW —18 Points
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1 SOLARPANL
Commercial Solar Panel
E
SOLAR-COMM
1 PHOTOVCOM
Photovoltaic System
Commercial/Multi-family
E
1 BSEISMICO
Seismic Commercial
E
1 ELCPLNCK
Plan Check Fee
E
I
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
COMM & RESID
1 SOLARRES
Residential Solar Panel
E
SOLAR-RES
Revised 08/20/2009
CITY OF CUPERTINO
SOLAR PANEL
PERMIT APPLICATION FORM
CUPERTINO
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PHOTOVRES
Photovoltaic System
Residential
E
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B