14070124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10742 CARVER DR CONTRACTOR:SUN WORK PERMIT NO: 14070124
RENEWABLE ENERGY PROJECTS
OWNER'S NAME: CHRIS CAMPO PO BOX 60250 DATE ISSUED:07/29/2014
OWNER'S PHONE: 4088651340 PALO ALTO,CA 94306 PHONE NO:(650)520-9918
ja LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INSTALLATION OF ROOF MOUNTED SOLAR(10 PANELS)
License Class C—u6 Lic.# 92-0-732 (2.6 KW)
ur,Warfc KQ1newa 719 Zo1 y
Contractor Date
_?;41
hereby affirm that I am liced un er 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
-performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
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:37532009.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXP NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WI 80 DAYS OF IT 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 0 DAYS FRAM-U ST 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 '' f`"
granting of this permit. Additionally,the applicant understands and will comply Da
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature r� Date 7 Z 9 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)
1,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(a)should I store or handle hazardous
1 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 33,an 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Z9 ?VI
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,1 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,1 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.1 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
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(d1cupertino.org / /(/ ! z�)�� ,
CUPERTlNO
PROJECT ADDRESSAPN#
10
OWNER NAME PHONE E-MAIL
A`rNY t;�irti�f� UFS — XG5 �1It� r'ca� — C'=,4r c.I
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE -7 E-MAIL
M C.
STREET ADDRESS CITY,STATE,ZIP FAX
OWNER ❑ OwNER-BUILDER ❑ ORNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME AIT �� S�rJ LICENSE NUMBER ��73LICENSE TYPE��
-. BUS.LIC#
�2Z �6
COMPANY NAME, E-MAIL FAX
STREET ADDRESS ( I CITY,STATE,ZIP C CA 75*o? _ PH U F r_'1-7,
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Mlllti-Family PROJECT INWILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes R(No FLOOD ZONE ❑ Yes -eNo
SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 10 KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK I
RECEIVED BY:
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. 1 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 building construction. I authorize repr.Esentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicanUAgent: Date: -7 &e
SUPPLEMENTAL INFORMATMON REQUIRED "OFFICE USE ONLY
WOVER-THE-COUNTER
X.
❑!STANDARD
v
❑
'LARGE_�'•>
a
D 1 1NAJOR
PVAPP_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
WPERMIT
DDRESS: 10742 Carver Dr DATE: 07/29/2014 REVIEWED BY: Sean
PN: BP#: "VALUATION: $8,000
PE: Building Permit LAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE: A
WORK Installation of roof mounted solar 10 anels 2.6 K
SCOPE
Li
NOTE:This estimate does not include fees due to other Departments(i.e.Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Kesolution 11-053 E f/ 7;1:13J FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Alternative Energy System
Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? ® Yes (j) No $0.00 0
Advanced Planning, Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Strong, Motion Fee: IBSEISMICR $1.04 Select an Administrative Item
Wd�_, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.04 $236.00 TOTAL FEE: $238.04
Revised: 07/10/2014