13100020 CITY OF CUP]ERTINO BUILDING PERMIT
BUILDING ADDRESS: 7451 PROSPECT RD CONTRACTOR:CLEAN SOLAR PERMIT NO: 13100020
OWNER'S NAME: JACKSON GREGG AND CHELL MARY E 1445 KOLL CIR STE 109 DATE ISSUED: 10/01/2013
OWNER'S PHONE: 4088572823 SAN JOSE,CA 95112 PHONE NO:(408)217-8876
LICENSED CONTRACT'OR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class r'�-� Lie.to (�(v INSTALL 13 ROOF TOP FLUSH MOUNTED PV PANELS
Contractor
t!' r�C ,_4 �&rDate 13 (3.445KV)
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 REV#l CHANGING MODULES FROM 265 TO 260(3.38KW)
(commencing with Section 7000)of Division 3 of the Business&Professions -ISSUED 10/23/2013
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:$16071
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 APN Number 36615047.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTLED
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 FRO 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 Z�
granting of this permit. Additionally,the applicant understands and will comply Iss a e:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�SS 4E ROOFS:
Signature Date / J 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(Scc.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). 1 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(x)should 1 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,Sectiq 5,25533 an 25534.
Section 3700 of the Labor Code;for the performance of the work for which this D
permit is issued. Owner or authorized agent: Date: 2 /
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 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
I certify that t 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.
Signature Date
CITY OF CUPERTINO
FEE (ESTIMATOR- BUILDING DIVISION
ADDRESS: 13100020 DATE: 1012312013 REVIEWED BY: MELISSA
APN: 366 15 047 BP#: 13100020 *VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE:
WORK REV# 1 - CHANGE VOLTS & KW ONE PANELS. SAME # OF PANELS & SAME LOCATION **NO
SCOPE FEES**
Vecn flan Check f'furrrh.t'i;,r{'"freeF 1i1;c.Al w (1,"A..
,tech. rrnil Fee: F'ernii! ec.Pern;ir f°eco
011'rr'tech.insp. E3__L_ 011':er f'Irrrl,,frsf1. {7lher.li/:<<:. irsp.
Tech. ;rrsp. Fee: Phemb.Msp,Fire: Glec. lair. Foe:
NOTE: This eslin:ale does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Server District,School
District,etc. . These ees are based on the prelitnina. information available and are only an estimate. Contact lite De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Pen-nit Fee: $0.00
Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consrnicfion Tax: F
0Work Without Permit? O Yes E) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Trcfvel Documentation 1=ees: Building or Structure
d
Strong Motion Fee. $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $0.00 TOTAL FEE: $0.00
Revised: 10/01/2013
CITE' OF tCUP1ERTINO BUILDING PERMIT
BUILDING ADDRESS: 7451 PROSPECT RD CONTRACTOR:CLEAN SOLAR PERMIT NO: 13100020
OWNER'S NAME: JACKSON GREGG AND CHELL MARY E 1445 KOLL CIR STE 109 DATE ISSUED: 10/01/2013
OWNER'S PHONE: 4088572823 SAN JOSE,CA 95112 PHONE NO:(408)217-8876
FLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
I
Lic.enses {0 �C. Lic,b (� 1 INSTALL 13 ROOF TOP FLUSH MOUNTED PV PANELS
1. f {3,115KW)
Contractor r (P(�-f _� a 1 Date I t C I
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Seetion 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:$16071
1 have and will maintain Worker's Compensation Insurance,as provided for by
FF Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36615047.00 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.1 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 + AS 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 Y
with al non-p 'nt source regulations ppper the Cupertino Municipal Code,Section
9.18.
a RE-ROOFS:
Signature _ _ Date /I� 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 Lew 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(Seo.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
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(x)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 I
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 ecti ns 550 5533,and 55 4.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,l 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
1 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, 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
FEE IES71MA 0R- BUILDING IDIVISION
ADDRESS: 7451 PROSPECT RD DATE: 10/01/2013 REVIEWED BY: MELISSA
APN: 366 15 047 BP#: l� 'VALUATION: 1$16,071
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE:
WORK INSTALL 13 ROOF TOP FLUSH MOUNTED PV PANELS 3.445kW
SCOPE
,bfeGh. flan Check Phunh. Plan Check Elec. Plan Check
itlech. Perwil Fee: Phimb, Pei7nit Fere: liler. Permir Fee:
fhher,ifech.Insp. Ll Other Plumb Insp. E]__L_ Ocher Elcc.Insp.
07-
A-Tc(h. ht.,p. Fee- Phunb. Insp. Fee: Elec.Insp,Fee:
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 prelimina information available and are onl an estimate- Contact the De t or addn'l info.
FEE ITEMS(Fee Resolulion 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. O OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tire-:
Administrative Fee: O
Work Without Permit? ® Yes 0 No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Truvel Douianenlation Fees: Building or Structure
Strong Motion Fee. IBSEISMICR $1.61 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 7
SUBTOTALS: $2.61 $229.00 TOTAL FEE: $231.61
Revised: 08101/2013