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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10708 STEVENS CANYON RD CONTRACTOR:SUNGATE ENERGY PERMIT NO:09120083
SOLUTIONS
OWNER'S NAME: BAJARIG&HUANG 6335 FERRIS SQ STE B DATE ISSUED:01/21/2010
OWNER'S PHONE: 4085981598 SAN DIEGO,CA 92121 PHONE NO:(858)457-4500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class
Lic.#
MECH r RESIDENTIAL F_ COMMERCIAL
Contractor SUN jt;46r_4,kZ- Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL 1.5 KW PV SYSTEM
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$28000
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. APN Number:35603058.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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- oint source regul ions per the Cupertino Municipal Code,Section Issued by-- Date:
9.18. ) �? .
Signatur Date
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contraetor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
wil I 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this 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
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Own efli r a orized gent:
Compensation laws of California. If,after making this certificate of exemption,I ( Date: f
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the ipplicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per a Cupertino Municipal Code,Section
9.18. //� / Licensed Professional
Signature /t/`Date 1 ,,xr [ l a
CITY OF CUPERTINO 09 � :2_0
SOLAR PANEL
PERMIT APPLICATION FORM
CUPERTINO
APN # Date:
Building Address:
Owner's Name: Phone#:
i y06-s9r- vs
C ntractor: Phone#: Sfo-93 a.� i '-- 97 7 Contractor License#:
�t4 Fax #: Jro- 3b} - 7 8ro 70 °9
Contact: Phone#: Cupertino Business License#:
Fax#:
Job Description: >5t-fL
Residential F1 Commercial ❑ Number of Panels/Units: Kilowatts: `. S
Valuation(cost of project):
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 Permit Type
Group
1 SOLARPANL Commercial Solar Panel E SOLAR-COMM
1PHOTOVCOM Photovoltaic System E
Commercial/Multi-family
1BSEISMICO Seismic Commercial E
1 ELCPLNCK Plan Check Fee E
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
P Commission Fee COMM & RESID
1 1SOLARRES Residential Solar Panel E SOLAR-RES
Revised 08/20/2009
1
CITY OF CUPERTINO
SOLAR PANEL
PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Permit Type
Group
1 PHOTOVRES Photovoltaic System E
Residential
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
Community Development
103 00 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
CUPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
a o3 i2o. O z x-60
OWNER'S NAME:64j4g c y PHONE #
GENERAL CONTRACTOR: - C�trffl' FARC#
I am not using any subcontractors: Vo'�
Signature Date
Please check applicable subcontractors and complete the following information:
21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
l� ii v
Owner/Contractor Signature 6ate