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1501006210i P/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19060 MEIGGS LN CONTRACTOR: SANTA CRUZ WESTSIDE PERMIT NO: 15010062 ELECTRIC OWNER'S NAME: CHUNG SIMON LOONG AND CHU LAY CHIN 2119 DELAWARE AVE DATE ISSUED: 01/12/2015 OW R'S PHONE: 4082423916 SANTA CRUZ, CA 95060 PHONE NO: (831) 469-8888 KLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �y/ License Class- �/�_ Lic. 4 S(��� INSTALL 24 ROOF TOP, FLUSH MOUNTED PV PANELS 5.28 KW • Contractor Date I hereby irm tha wensed under the provisi s of apter 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: I ave and will maintain a certificate of consent to self -insure for Worker's o sation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $21000 form nee of the work for which this permit is issued. av nd 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 APN Number: 37535052.00 Occupancy Type: ermit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PEIVIIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D ALLED INSPECT ON. 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 com Y Date: with all non -point egulat ons per the Cupertino Municipal Code, Secti 9.18. RE -ROOFS: Signature Dat7Ofl 77"4--S All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino icipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sectio �33,�25534.� Owner or authorized ag Date: permit is issued. 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must l hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the l understand my plans shall be used as public records. granting mit. Additionally, the applicant understands and will mply with a non -point source spa ection Licensed Professional 9.18. Signature ate iZ CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org V) 2 �0�AE PROJECT ADDRESS � APN II �� C J llllll OWNER NAME PHON /E-MAIL STREET ADDRESS jAiFAX CITY, STATE, ZIP knO l�" C� CONTACT NAME II PHON t ' E-MAIL1 ` CICT"- 0 0 I�q. t✓Ic�JC- J` •� . STREET ADDRESS2 CITY, STATE, ZIP FA 1� ❑ OWNER ❑ OWNER-13LJILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTR TOR AME �t,[C;ESE NUMBE LICEr'6ETYPE BUS. LIC # �� 1� �C COMPANY NAME E-MAIL FA 15 _C:r - STREET ADDRESS^,` CITY, STATE, ZIP �C �, PHONE `C.n 1 ( ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL c FAX STREET ADDRESS CITY, STATE, ZIP if PHONE USE OF SFD Or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO STRUCTURE. 'OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER F-0RS0/.ARPANE1_S': NUMBEROF PANELS/UNITS. KILOWATTS (COMMERCIAL ONLY) e7 !_ TOTAL VALUATION: 000 DESCRIPTION OF WORK - Gf c_'__,t 1 I : r C� C By my signature below, I certify to each of the f llowing: I e read this the property owner or authorized agent to ct on the pro,�r�)rorp application and the information I ha p vided s co ec ) ve read the Description of Work and verify it etrth all applicable local ordinances and state laws relating build g ns c authorize representatives of Cupertino to enter the above-ide�inspection purposes. Signature Applicant/Agent: Date: of LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER W ❑ EXPRESS a E�+ x ❑ STANDARD U a ❑ LARGE F ❑ MAJOR PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19060 MEIGGS LN FEE DATE: 01/12/2015 REVIEWED BY: MELISSA APN: 375 35 052 BP#: l �� `VALUATION: 1$21,000 'PERMIT TYPE: Building Permit 1 # $236.00 PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION SOLAR -RE PERMIT TYPE: A WORK INSTALL 24 ROOF TOP FLUSH MOUNTED PV PANELS 5.28 kW SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn I info. FEE ITEMS (Fee Resolution I1-053 Eff: ?/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 G Work Without Permit? © Yes (j) No $0.00 Advancecl Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Strom, Motion Fee: IBSEISMICR $2.73 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.73 $236.00 TOTAL FEE: $239.73 Revised: 01/06/2015 Q m v z tl O F O o U W X Z Z Q a 2 w yu O(n axw O ° tlom S Z p ow o 2vao ZW F- a¢2f Fn i=- m qhO ) d no 0 0O s�o3 zp O G J g 0 a _a N wl a Z 0 LL O LL LL U W t rc 4 Y K a a .Z W O O O W W a w x?z j w w ul O° z LL U m Z °Wm J o'0- W u <c '`�•N- K W O W z m rpY o>t'a O w ? 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