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14120055I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10395 MELISSA CT CONTRACTOR: CLEAN SOLAR PERMIT NO: 14120055 OWNER'S NAME: SMENTEK DAVID R 1445 KOLL C1R STE 109 DATE ISSUED: 12/10/2014 OWNER'S PHONE: 4085755703 SAN JOSE, CA 95112 PHONE NO: (408) 217-8876 ❑ LIC�NSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] C-. INSTALLATION OF ROOF MOUNTED SOLAR (10 License Class_._„__.....__ Lic.N q (Q�� MODULES) ��t..f/h.. (3.012 KW) Contracto/^ 1r�� D � Date 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. 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 Sq. Ft Floor Area: Valuation: $30000 rformance 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 APN Number: 34245017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION ertify that 1 have read this application and state that the above information is PERMIT E S IF WO IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 AYS OF PERMIT 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 DAYS FR CALLED INSPECTION. 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 Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section ROOFS: 9.18. /r� �� / Si tur Date �[ `—(” All roofs shall be inspected prior to anyny roofing material being installed. If roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stricture 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this r Owner or auth ize a e Date:IT �f permit is issued. 1 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 die Worker's Compensation laws of California If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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. 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 ARCHITECT'S DECLARATION indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO Ll 1 1:7 00 �'6 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.org PROJECT ADDRESS (} L t ho 2aL APN H U G ERNAM� E — gS, U I E-MAIL R S C* CIT STATE ZIP FAX C ACT NAME E-MAIL C FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTOR NAME LICENS,LjCENSE T E BUS. LIC a CO Y NAME E-MAIL FAX ST RESS ` - CITY, TE, ZIP �j PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF j2'-SFD Or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes -E2—NO PROJECT IN FLOOD ZONE ❑ Yes ,2r SOLAR PANELS 11ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER DATING ❑ OTHER: FORSOL,IRPANELS: N'UMBEROFPANELS/UNITS: ' KILOWATTS (COMMERCIAL ONLY): � 1� TOTAL VALUATION: ; (9(91/ �0 DESCRIPTION OF WORK • O/g By my signature below, I certify 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 provide correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat'ng to buildingonstruction. I author' e representatives of Cupertino to enter the above-iientified property for inspection purposes. Signature of Applicant/Agen ' Date: / // // INFORMATION REQUIRED PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION 10 ADDRESS: 10395 Melissa Ct FEE DATE: 12/10/2014 REVIEWED BY: Sean APN: BP#: 05 -VALUATION: $30,000 1PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAIVIATION SOLAR -RES PERMIT TYPE: WORK Installation of roof mounted solar 10 modules 3.012 k PME Plan Check: SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitaty Sewer District, School nictrirt_ etr ). Thaw frac are haled an the nreliminary information available and are only an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef: 7i1'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: Q Reg. Q OT T0.0Thrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SuppL Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Strome Motion Fee: 1BSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5.90, $236.00 TOTAL FEE. 1 $241.90 Revised: 10/0112014