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B-2017-0820CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0820 22826 SAN JUAN RD CUPERTINO, CA 95014 (342 21 028) ALLTERRA ENVIRONMENTAL INC SANTA CRUZ, CA 95060 OWNER'S NAME: COSTA PAUL AND PAMELA TRUSTEE & ET AL OWNER'S PHONE: 408-425-3233 LICENSED CONTRACTOR'S DECLARATION License Class CC -10 Lic. #BAZ973 Contractor A T R A ENVIRONMENTAL INCDate 10/31/2018 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: t. 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. 2. 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 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. Signature J?lJ � 6X �x Date C122- ZoR I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. 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. z. 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. 3. 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. Signature Date DATE ISSUED: 05/23/2017 PHONE NO: (831) 425-2608 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 4 -PANEL ROOF MOUNTED PV SYSTEM (1.16 KW) Sq. Ft Floor Area: I Valuation: $4000.00 APN Number: Occupancy Type: 342 21 028 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 05/23/2017 RF ­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 Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION CONSTRUCTIONLENDING 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • build ingQcupertino.orA B?-Wll - n gzn PROJECT ADDRESS -2_0 2_/ _ /� e !, �P� /� ^ , v APN # 3 q2 _ Z� ^ d Z V OWNERNAME � T� V co c. ` (� t� PHONE 40 D �`7 ��3� E-MAIL {_ STREET ADDRESS S�4til E CITY, STATE, ZIP �.t oc FAX CONTACT NAME Shawn Murphy PHONE 425-2608 �M"'shawn@aliterraenv.com STREET ADDRESS 207B McPherson St. CITY, STATE, ZIP Santa Cruz, CA 95060 FAx ❑ OWNER ❑ OWNER-BmDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR. AGENT ❑ ARCHITECT ® ENGMER ❑ DEWLOPFR ❑ TENANT CONTRACTOR NAME Aliterra Solar CIMTYPE L[CENSENBER 847973 LICENSE C10 C4 BUS. LIC# 33088 COMPANY NAME Aliterra Solar E-MAILshawn@allterraenv.com shawn@allterraenv.com FAX STREET ADDRESS 207B McPherson St. CITY, STATE, ZIP Santa Cruz CA 95060 PHO 31 425-2608 ARCHITECT/ENGINEER 12o`' e rt Shawn Mur h LICENSE NUNIBER M 026199 BUS. LIC 4 33088 COMPANY NANIE Aliterra Solar E-MAIL shawn@aliterraenv.com FAX , STREET ADDRESS 207B McPherson St. CITY, STATE, ZIP Santa Cruz, CA 95060 PHO 831 425-2608 USE OF ❑ SFT) or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO ❑ SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOL4R PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL YVALUATI 0(� � DESCRIPTION OF WORK (C � �1 4 ` 6 � o, 11, � T C ` 1vs�l r W thA �kJ_ c --)C G Y-Ui DL DT) So LAP--,' MODULE� 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 provided is 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 relating to ing auction I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: �� 2�� SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER TRE-COIJIMR y ❑ EXPRESS ❑ srArmARn ❑ LARGE a ❑ MAJOR '