10110003CITY OF CUPERTINO BUILDING PE IT
BUILDING ADDRESS: 10878 SYCAMORE CT CONTRACTOR: HORIZON ENERGY PERMIT NO: 10110003
SYSTEMS
OWNER'S NAME: DAVE MEHUYF
P O BOX 320612 1 DATE ISSUED: 11/19/2010
OWNER'S PHONE: 4087148067 1 LOS GATOS, CA 95032 PHONE NO: (408) 978-0111 1,
LICENSED CONTRACTOR'S DECLARATION
�!
License Class Q C b Lic. # - /4 n /
I " 6" 0f�y y--1�-%
Contractor (•�ty (.� Date C,
1 hereby affirm that 1 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.
1 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.
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. 10 I_
APPLICANT CERTIFICATION
I 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 it C1
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 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)
I, 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.
I certify that in the performance of the work for which this permit is issued, l 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, l
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.
APPLICANT CERTIFICATION
I 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
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: INSTALL SOLAR PANEL ON EX ROOF, FLUSH MOUNTED
GRID
TIED NO BATTERY BACK UP SYSTEM
Sq. Ft Floor Area: I Valuation: $34197
APN Number: 34225036.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
07r or author agent: 6
61 �,�� Date:—L 1 0
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 Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10374 S TANTAU AVE
OWNER'S NAME: FALCO FORBRICH
OWNER'S PHONE: 4087771213
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 8 Lie. #_2 Ot Z &
Contractor :JA ra? Date 1 2 4?1 2W o
1 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.
CONTRACTOR: JB COIF STRUCTION PERMIT NO: 101 10038
1484 RAMON DR DATE ISSUED: 11/29/2010
SUNNYVALE, CA 94084 PHONE NO: (408)739-9581
BUILDING PERMIT INFO: BLDG I ELECT r PLUMB r
MECII RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: ADD MASTER BEDROOM & MASTER BATH
(229SQ);SERVICE
UPGRADE 200 AMPS,NEW HVAC SYSTEM, NO RE -ROOF & NO
STRUCTURAL
1 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.
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. I Sq. Ft Floor Area:
APPLICANT CERTIFICATION
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
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 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.
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 pennit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If, after making this certificate of exemption,
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.
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
APN Number:
Valuation: 568500
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 PAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date: /",ZZ— �l
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or au 0 ' ed agent;
Date:
CONaTRUCTION LENDING AGENCY
1 hereby arnm 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
1 understand my plans shall be used as public records.
♦% r�J'JJJjS JIifJJ.IIJ-!rI,.ii - f Ur`rli"TJ I f��!
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Permit Number 10110003
Status "
C - Closed
Contractor " Defined Fields
Master Number
IQI Notes
Project
SOLAR -RES
IQI
Apply Date `
11/01/2010
ff-D Operator
Permit Issue Date
11/19/2010
Operator
Certificate Issued
12/13/2010
Operator
Certificate Type
CC - CERTIFICATE OF COMPL
Certificate Number
0
Address " I 10878 SYCAMORE CT
City/State/Zip CUPERTINO CA 95014
2 APN 34225036.00
IQI Unit
SylviaM Fn:it,, irforrnaii_r
TraciC I Owner Name'I DAVE MEHUYF
bobg Use Default ❑
Address Home -10878 SYCAMORE CT
Permit , Property
Zoning Applicant
Contractor " Defined Fields
Permit Details
Permit Type `
SOLAR -RES
IQI
RESIDENTIAL SOLAR PANEL
Usage Class `
N/A
IQI
NON APPLICABLE
Applied Value
34197
SQUARE FT.
0
Calculated Value
0 IEI
US C-404 Type
434
ICQI
ALT: RESIDENTIAL
Permit Form
AUTOPERM - PERMIT
Ownership
1 - Private
Project Size
EXPRESS -EXPRESS
Permit issued 11/19/2010
Fnhar Fha m irnncu nr �nw cnarial rnnr*inr.c fnr Fhi, narmiF
City/State/Zip CUPERTINO CA 95014
Purpose/Special Conditions
INSTALL SOLAR PANEL ON EX ROOF, FLUSH MOUNTED GRID
TIED NO BATTERY BACK UP SYSTEM
SCANNED/ FILMED 8/2011
I[OAdd Default Text
N1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10878 SYCAMORE CT
CONTRACTOR: HORIZON ENERGY
PERMIT NO: 10110003
SYSTEMS
OWNER'S NAME: DAVE MEHUYF
P O BOX 320612
DATE ISSUED: 11/19/2010
OWNER'S PHONE: 4087148067
LOS GATOS, CA 95032
PHONE NO: (408) 978-0111
LICENSED CONTRACTOR'S DECLARATION
License Class Q C l 6 Lic. # �—t � �3 1
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r— M r"'°
^ f'
Contractor � �� �'rfy Date r` C1
f �i-17 f 2vh
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: INSTALL SOLAR PANEL ON EX ROOF, FLUSH MOUNTED
(commencing with Section 7000) of Division 3 of the Business & Professions
GRID
TIED NO BATTERY BACK UP SYSTEM
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
Sq. Ft Floor Area:
Valuation: $34197
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. A-
APN Number: 34225036.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
,
Signature (��/� DatcJJt /13
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Ow er or authorized agent:
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
M�J-11
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
'J
1.0
CM of
CUPEVINO
CITY OF CUPERTINO
SOLAR PANEL
PERMIT APPLICATION FORM
AlIX6 3
APN #
v 3(iq
Date: L `)
l �(
Building Address: 0 SC �M C1
Permit Type
Owner's Name:
VCJ V40- Y
yb� -7
Contractor: Phone #: Y t `1?
Contractor License #:
Fax #: `f C/ — y v U - r/ Q-
Photovoltaic System
Commercial/Multi-family
Contact:
Phone #: yO�- 14(2- tJ-q,?
Fax #: 0%- cl - V -/P'/
Cupertino Business License #:
Number of Panels/Units:
Kilowatts (Commercial Only):
Z
Job Description:
mac+
All UGC � }� � �� .M�
�
� Com- S �� ✓'�
1 ELCPLNCK
Project Size: ExpressK
Standard ❑ Large ❑ Major ❑
Residential
Commercial ❑ Valuation (cost of project):
Green Points:
1BCBSC
Cal Bldg Standards
Commission Fee
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
1PHOTOVCOM
Photovoltaic System
Commercial/Multi-family
E
1BSEISMICO
Seismic Commercial
E
1 ELCPLNCK
Plan Check Fee
E
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
COMM & RESID
1SOLARRES
Residential Solar Panel
E
SOLAR -RES
Revised 07/06/09