Loading...
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