15010152CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22826 SAN JUAN RD
CONTRACTOR: SOLAR CENTER
PERMIT NO: 15010152
ONNINER'S NAME:
MENLO PARK, CA 94025
PHONE NO: (650) 327-3200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
INSTALL 12 ROOF TOP, FLUSH MOUNTED PV PANELS
LicenseClass y(a d�� Lic. # �C C /�
(3.36 KW)
Contractor 2 l
(�-,-� '�+`b."-lam Date
I hereby affirm that 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:
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
Sq. Ft Floor Area:
Valuation: $16790
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
APN Number: 34221028.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN I S 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
AYS FR LED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this per " Add' onally, the applicant understands and will comply
Is _ Date:
with all non-poin o re lations per the Cupertino Municipal Code, Section
9.18.
/� Z� _ �� -
RE -ROOFS:
Signature Date
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.
❑ 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
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)
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. 1 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(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 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,
Section 3700 of the Labor Code, for the performance of the work for which this
/' 2� -/S'
Owner or authorized agent: Date:
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 the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
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 (See. 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrirt. otr. ) Thoco font aro hncod nn tho nrolimbiary infnrmnYian nvailahlo and aro nnhi an intimato_ Cnntart tho hent far nddn'l infn_
FEE ITEMS (Fee Resolution 11-053 Elf, 7/1-73)
ADDRESS: 22826 SAN JUAN RD
DATE: 01/27/2015
REVIEWED BY: MELISSA
MISC ITEMS
APN: 342 21 028 BP#:
-VALUATION: 1$16,790
'` PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARYSFD or Duplex
USE:
$0.00
PENTAMATION SOLAR -RE
PERMIT TYPE: i
WORK
INSTALL 12 ROOF TOP FLUSH MOUNTED PV PANELS 3.36 kW
SCOPE
0,0
NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrirt. otr. ) Thoco font aro hncod nn tho nrolimbiary infnrmnYian nvailahlo and aro nnhi an intimato_ Cnntart tho hent far nddn'l infn_
FEE ITEMS (Fee Resolution 11-053 Elf, 7/1-73)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Q Reg. 0 OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
Q OT
FO.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
(F)
Work Without Permit? Q Yes (j) No
$0.00
Advanced Planning, Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Strong; Motion Fee:
IBSEISMICR
$2.18
Select an Administrative Item
B➢d Stds Commission Fee: IBCBSC
$1.00
SUBTOTAL$: '
$3.18
$236.00
TOTAL FEE:
1 $239.18
Revised: 01/06/2015