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B-2016-2121 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2121 10545 MIRA VISTA AVE CUPERTINO,CA 95014-2707(357 05 002) ALL BAY SOLAR SAN FRANCISCO,CA 94112 OWNER'S NAME: MILLER MATTHEW D AND STEPHANIE S TRUSTEE DATE ISSUED:06/13/2016 OWNER'S PHONE:650-799-2620 PHONE NO:(415)655-3090 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10:C-46 Lic.#962034 Contractor ALL BAY SOLAR Date 06/30/2017 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: (N)27 PANEL ROOF-MOUNTED PV SYSTEM(9.45 KW) I hereby affirm under penalty of perjury one of the following two declarations: wi. 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. 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. Sq.Ft Floor Area: Valuation:$30000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 357 and state laws relating to building construction,and hereby authorize 357 OS 002 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Yx4x �-� Date 6/13/2016 Issued by:Abby yende gy�A_�lDate:06/13/2016 &V„L OWR-BUILD R DECLARATI N I hereby affirm that am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/13/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ' be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:6/13/2016 I certify that I have read this application and state that the above information is CONSTRUCTI011(LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/13/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• building cDcuoertino.orq 'R`W -2`�-I CUPERTINO PROJECT ADDRESS1®f3q.5 Ara ` I APNR °1as OWNER NAME A40\-P-(- PHONE 65 f �6� Oj E-7MAIL e p STREET ADDRESSZrG 9 pI 5� CITY, STATE,ZIP �fl� �I I FAX CONTACT NAME ✓ PHONE J I E-MAIL STREET ADDRESS CTTY,STATE,ZIP FAX ❑ ORR.'ER ❑ O'AWER-BUILDER ❑ ORT'ERAGENT ❑ CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DZVMLOPER ❑ TENANT CONrrRACTOR NAhM r`a�I A�. I cc f�� LICENSE NU7 "ERg6 2,3 y LI�ENSE TYPE BUS.LIC COMPANY NAME �Il ©/� 1f I E-MAIL SOIIGI ��� FAX STREET;ADDRESS ©� a I ,D -5 CITYSTATE,ZIP' � C� /Z PHONE52A �I/5-s0 ARCHrTECT/ENGINEER NAME �v� LICENSE NUMBER BUS.LIC R/ 4 COMPANY NAME FM.-UL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROSECT IN WILDLAND PROJECT Al STRUCTURE: ❑ COMMe'rCial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/IlN1TS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: D ^ DESCRIPTION OF WORK J 'j RECEDED BY T c3 a v s T `u M - ,.ft;.:'sir.��}�.�z�».•. By my signature below,I certiiar to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b i] ing const tion. I authorize representatives of Cupertino to enter the above-id ntified property for inspection purposes. Signature ofApplican/Agent: Date: SUP EMEl\ AL (FORMATION REQUIRED `-{ ~"3 . .•t zOF'kTMatz O MIN ' �_GYERTJ Oir �r t i}y UI�TEIt,wf. 122.�'11. 4 Mom ���F��� �LC Z Vv' PT App_2011.doc revised 03/16111