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15040035a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10510 N STELLING RD CONTRACTOR- PERMIT NO: 15040035 OWNER'S NAME: THINH PHAN & ANH DAO 1 1 DATE ISSUED: 04/06/2015 1 1 OWNER'S PHONE: 4088390310 1 , 1 PHONE NO: 1 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor GdAT AA r: S4114ate 4- C, - I 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: 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. 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 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. i 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. 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, 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 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 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. Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL 0 INSTALL 16 ROOF TOP, FLUSH MOUNTED PV MODULES (4.48KW) Sq. Ft Floor Area: Valuation: $9800 APN Number: 32630101.10510 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRO LED INSPECTION. 0///J�_ 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 Appli 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.,1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 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 2555, 25,S3,3;1and 25534. Owner or authorized agent: f Date: 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional ALTERNATIVE ENERGY PERMIT APPLICATION o�7� COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION a� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 4 (408) 777-3228 • FAX (408) 777-333 • building(a cuoertino.org PROJECT ADDRESSAPN 105 K) t� - STS. LLKJGr Rr*- OWNER NAMEPHONE ,�4N 1� �A� 'VA4 E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME t PHO CA E-M.AIL K _ 10 8STREET ADDRESS CITY, STATE, ZIP FAX ❑ OVNER ❑ OWNER -BULL DER ❑ OVINTR AGENT 61 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEN ELOPER ❑ TENAN'T CON I RACTOR NAh4ELICENSE R Cz 1 -1-1 1S E;L SZ) LAP, NUt BER 6 3 LICENSE PE L BUS. LIC R COMPANY NAME E-MAIL FAX So +A �E-r >J sa ,3c STREET ADDRESS t'o —nu' -A -I' Ii is CITY, STATE, ZIP PHONE ARC HITE^T/ENGINEER�N�`SE LICENSE I.'UMBER BUS. LIC ►.1 rN Z.o COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAMD PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No OLAR PANELSEl ELECTRIC VEHICLE CHARGING STATION ElSOLAR WATER HEATING ❑ OTHER:FORSOLARPANELS, NUMBEROFPANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): tL_'w ALVALUAT11Lt'sR LT DESCRIPTION OF WORK 9�tJ,".-.i"xa ✓ Si a, r',�i',M} �4' ,P at �:'t �k 5n'� d "i�.�&°� >;k, `!i� ��;. By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property e ' a f. I have read this application and the information I hav�provided 'correct.I have read the Description ofWork and verify it is accurate. I aga to comply with all applicable local ordinances and state laws relating to tru ' I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. SignatureofApp] icandAgent: Date: SUPPLEMENTAL rNFORMATION REQUIRED " r�zc dzr E 4 - SSY 7�f Y'✓9a:`'`a�t t;..X.t`.i,,''%'�k L �TFIF.Cy0IT1�TERj`i�� P VApp_2011. doc revised 03/16/11 2 CITY OF CUPERTINO IM -M FEE ESTIMATOR - BUILDING DIVISION laADDRESS: 10510 N STELLING RD DATE: 04/06/2015 REVIEWED BY: MELISSA l APN: 326 30 101 BP#: VALUATION: 1$9,800 `PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: Q Reg. 0 OT PENTAMATION SOLAR -RES PERMIT TYPE: WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.48k SCOPE i NOTE: This estimate does not include fees due to other Departments (Le. 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 addi info. FEE ITEMS (Fee Resolution 11-053 Eff 7//,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. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT r0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Wit r ecriuFr lt/,l �-. I I E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i ati=, l /)n� Strong Motion Fee: 1BSEISNYCR $1.27 Select an Administrative Item Bldg; Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS:1 $2.27 $236.00 TUTAL VEE: 1 $238.27 Revised: 02/14/2015