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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��! File Edit Actions Details Links Favorites Help 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