14030062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10353 IMPERIAL AVE CONTRACTOR:RFC SOLAR,INC. PERMIT NO: 14030062
OWNER'S NAME: ALAN KUTE 775 FIERO LN STE 200 DATE ISSUED:03/12/2014
OWNER'S PHONE: 4082212358 SAN LUIS OBISPO,CA 93401 PHONE NO:(888)657-6527
Lb LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F]
INSTALL 32 FLUSH ROOF MOUNTED PV PANELS(8.16KW)
License Class C- N? Lie.# �'�
Contractor REr- Soleo r rim Date 3 '(Q. �y
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:
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. Sq.Ft Floor Area: Valuation:$22451
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:35719044.00 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. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS 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 __ T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judg
costs,and expenses which may accrue against said City in consequence of the t�
granting of this permit. Additionally,the applicant understands and will comply Issued by: Da e: /
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
(� RE-ROOFS:
Signature Date 1 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
[hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. 1 will
1 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 1
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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ?
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,l must 1 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
1 certify that 1 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments, -
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,
ALTERNATIVE ENERGY PERMIT APPLICATION OQ
12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 17
10300 TORRE AVENUE •CUPERT]NO, CA 95014-3255 `'XO
AE
CUPERTINO (408) 777-3228• FAX (408)777-3333• buildina(5)culpertino.org
PROJECT ADDRESSt� J '1 s2 lyylw" '
l APN# -5 5 71
T. „
OWNERNAME �C I '((. _e_ PHONE OQ , 221 -235S� E-MAIL
STREET ADDRESS v L z Q /1 i� CITY, STATE,ZIP( J�J FAX
CONTACT NAME cC_ SO J U" w PHONE jn r_ ��J _ O�r I E-MAIL �� u^InI9��C�1 IQ' /
STREET ADDRESS 3O V lJam►^le(V �J L� CITY.STATE. Z\I/Pb f QV, O ! V"' �5�3 FAX V W,L.,-1
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT R_C"NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE p /- BUS.LIC#
COMPANY NAME/ /J{p E-MAIL hI, I� aCSO FAX
STREET ADDRESS 23ro� Z� 7 ^�1 _�4 1 L CITY,STATE,V (� [�5 I�I PHONE
ARCHITECT/ENGINEER NAME ( `( 1 LICENSE NUMBER J ( ( BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF EjSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE. ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
LAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER
FOR S'OIAR PANELS.- NUMBER OF PANELS/UNITS: 5Z
H KILOWATTS: CI I� L� jt,
O L,Vrg1L ATTI N�`
DESCRIPTION OF WORK �/� I ( �1^ �fm o [3 IZ u
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 ehalf. 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 constructs n.It authorize representatives of Cupertino to enter a3
the above-rr'deifie�property for inspection purposes.
Signature of Applicant/Aeent: Q Date: VW
SUPPLEMEN AL INFORMATION REQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
c.
F ❑ EXPRESS
U
STANDARD
a LARGE
c.
MAJOR
PVApp_2012.doc revised 06120112
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10353 IMPERIAL AVE DATE: 03110/2014 REVIEWED BY: MELISSA
APN: 357 19 044 BP#: a U o2 'VALUATION: $22,451
RPERM TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE:
WORK INSTALL 32 FLUSH ROOF MOUNTED PV PANELS 8.16kW
SCOPE
Lj
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 Dept/or addn'i info.
FEE ITEMS (Fee Resolution 11-0533 Ef: ?,l%131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L__I_j # Alternative Energy System
Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.(D Reg. Q OT p,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (2) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G)
Building or Structure 0
i
Strom Motion Fee: 1BSEISMICR $2.25 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.25 $229.00 TOTAL FEE: $232.25
Revised: 01/1512014
PHOTOVOLTAIC SUBMITTAL CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333• building pncupertino.orq
GENERAL INFORMATION
This submittal checklist can be used to determine and verify completeness of a photovoltaic permit application.
Upon verification of a complete submittal package, please submit four sets of plans and supporting documents
to the Building Department for review and approval.
PLANS/DOCUMENTATION INFORMATION
COMPLETED BY
APPLICATION SUBMITTAL INFORMATION STAFF
Required Provided
check check
Documented cost estimate to establish valuation 21, ❑
U �r Provide two copies structural calculations, prepared by a registered California
4 Z design professional for roof mounted systems if the total weight of the PV
F+ W system is over five pounds per square foot or if the maximum height above the ❑
a0 roof surface exceeds 18 inches; or if the total height of the PV system
a* U exceeds five feet in height for ground mounted systems
00 Manufacturer's Specifications for all equipment. ❑
Provide Manufacturer's Installation Instructions for all PV modules, mounting ❑
systems, combiner boxes if used), inverters, and disconnects.
Name of property owner
W W Address of property owner Q ❑
C x Scope of work documented on the plans ❑
U `" Project Data (including assessor's parcel number, use of building, etc.) ❑
Site plan including property boundaries and north arrow clearly identifying the
dlocation of the PV installation. [� ❑
*4 Site Plan shall indicate location of electrical service, combiner box, inverter, a/c
a, & d/c disconnects, junction boxes and battery banks.
FW. Site Plan for Ground mounted systems shall identify all structures on property,
ri topography of site, driveway access from street, easements, site utilities, septic ❑ ❑
system with leach lines, etc.
Roof Mount:
Z Provide Roof Plan indicating location and total coverage (area) of PV array.
C Roof plan shall show adequate access and pathways based on the Solar
F Voltaic Installation Guide by the State Fire Marshal's Office and CalFire: ❑
U Z htt ://osfm.fire.ca. ov/ df/re orts/solar hotovoltaic uideline. d
aProvide Partial Roof Framing Plan identifying size and spans of members that
E support the PV system
EJ
4 Provide details indicating attachment of PV modules to roof framing. Verify ❑
0 method of waterproofing and flashing.
Ground Mount:
Foundation Plan with foundation details referenced to applicable details. ❑ ❑
PhotovoltaicSubmittalChecklist 2011.docrevised 07/01/12
Electrical single-line diagram clearly identifying all devices installed in the PV system
and indicating total kVA rating of system. 1)Array wiring identified 2) Er ❑
Combiner/junction box identified 3) Equipment grounding specified 4) Disconnect
Z specified 5 Inverterspecified 6 System grounding specified
dClearly identify the point of interconnection with the utility supplied wiring system and �' Elpa., provide details on main breaker, PV breaker and rating of bussing.
04 d Indicate type and size of all conduit and conductors throughout the PV system
V Provide typical detail of signage. Signage shall be green or red plastic engraved with
El1/2"' high white letters, permanently mounted on or immediately next to the panel
F* door.
V Identify location of service disconnecting means and PV system disconnect (for PV
systems connected to utility services). Plans shall indicate that the inverter ❑
W disconnects are to be a separate component and serviceable. And, if applicable,
tans shall identify the building or area to be served.
Identify DC array solar panel Voc and Isc rating on plans. ❑
The installation of the PV system shall conform to the requirements of the 2010ElCalifornia Building Code and the 2010 California Electrical Code, Article 690 and any
Z other applicable articles or standards."
FW+ a Installation shall be provided by a California Licensed Contractor(B, C-46 or C-10). []
p- Buildings with stand alone systems shall have a placard indicating that it is a
Z standalone system and shall show the location of the disconnecting means. or
W ❑ ❑
W Buildings with utility services and a PV system shall have a plaque or directory
W indicating the location of the service disconnecting means and the PV system
Z ZO disconnecting means.
A Any solar structure that requires variation from the setback or height restriction of the
QA R1 Ordinance may be allowed with a minor Residential Permit(per Section ❑ ❑
19.28.090). Solar installations may not result in privacy impacts, shadowing, intrusive
noise or other adverse impacts to the surrounding area.
NOTE: All drawings must be signed by the person preparing them. All work shall comply with the 2010
California Building Code and the 2010 California Electrical Code, Article 690
PROJECT INFORMATION
SITE ADDRESS � AP N 35 719 0� DA�� D l�
OWNER NAME O PONE 1
c}n 1 22 -- 23
FEE ESTIMATE (The calculated fees are only an estimate. Contact the Bldg Dept for additional info.)
"USE OF BLDG: Single Family Dwelling Permit Fee
`VALUATION: Iso Strong Motion Fee
'QUANTITY: �� #of Systems Bldg Stds Commission Fee
TOTAL
PhotovoltaicSubnsittalChecklist 2011.doc revised 07/01/12