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15010176 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 1254 CATALINA CT CONTRACTOR:ALLTERRA PERMIT NO: 15010176 ENVIRONMENTAL,INC OWNER'S NAME: SANTA CRUZ,CA 95060 PHONE NO:(831)425-2608 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ INSTALL 14 ROOF TOP, FLUSH MOUNTED PV MODULES License Class 6—)o (--'I( Lic.# 1i� ;" (3.92KW)& 1 EV CHARGING STATION IN GARAGE ��l,Thty Tr NG• Contractor .q Ae?AA efty)t2c,tJMte 1/Z9/l5 I hereby affirm that I am licensed wider 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:$20000 J-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:35621040.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 180 DAYS FROM LAST ED 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 .� granting of this permit. Additionally,the applicant understands and will comply Issu Date: with all non-point source r lations per the Cupertino Municipal Code,Section 9.18. c� RE-ROOFS: Signature Date L 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 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) 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 I have and wil I 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 performance of the work for which this permit is issued. will maintain compliance with the the Health&Safety Code,Sections 2 5,Cuper 25533,and 25534.no Municipal Code,Chapter 9.12 and 1 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 G�"7/ �"� Owner or authorized agent: 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,1 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(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. 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 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. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 11254 CATALINA CT DATE: 01/29/2015 REVIEWED BY: MELISSA APN: 356 21 040 BP#: "VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: PERMIT TYPE: A WORK INSTALL 14 ROOF TOP FLUSH MOUNTED PV MODULES 3.92k & 1 EV CHARGING STATION SCOPE IN GARAGE F-1 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 preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolulion 1I-053 E..' 7/1.%13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Alternative Energy System Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 = # Alternative Energy System Permit Fee: $0.00 $109.00 1CHRGSTA EV Charging Station Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Per Fee: $0.00 T_T__ 0 Work Without Permit? © Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 A Strom Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 1 SUBTOTALS: $3.60 $345.001 TOTAL FEE: 1 $348.60 Revised: 01/06/2015