13110145 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10225 ANTHONY PL CONTRACTOR: SUNGATE PERMIT NO: 13110145
OWNER'S NAME: JOHN TROLLMAN DATE ISSUED: II/21/2013
OWNER'S PHONE: 4089730130 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
DECLARAT ON BUILDIG PERMIT INFO: BLDG r ELECT r PLUMB
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License CI Lic.# a0 o
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MECH RESIDENTIAL COMMERCIAL
Contractor Date r
I hereby,a�rihtlicensed under the provisions f Chapte 9
(commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION:
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations: INSTALL SOLAR PANELS AT EX. SFDWL 8 PANELS,2.1 KW
i. 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.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3.700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation: 12000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number: 34212072.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
granting of ' ermit kdditionally,the applicant understands and will com ly with WITHIN 80 DAYS OF PERMIT ISSUANCE OR
al I non-p u reg tions per the Cupertino Municipal Code Section .1 .
f
Signature Date 180 DA FROM LAST CALLED INSPECTION.
1� ��
Issued by: Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed
t. I,as owner of the property,or my employees with wages as their sole without first obtaining an inspection,I agree to remove all new materials for inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant: Date:
z. I,as owner of the property,am exclusively contracting with licensed contractors
to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the California
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. l will maintain compliance with
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section
Section 3700 of the Labor Code,for the performance of the work for.which this 25532(a)should I store or handle hazardous material. Additionally,should I use
permit is issued. equipment or devices which emit hazardous air contaminants as defined by the Bay Area
3. 1 certify that in the performance of the work for which this permit is issued,I shall Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code,Chapter 9.1 t Ith&Safety Code,Sections 25505,25533,and
not employ any person.in any manner so as to become subject to the Worker's 25534.
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 Owner or authorized agent: Date:
must forthwith comply with such provisions or this permit shall be deemed
revoked. CONSTR TION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's for
APPLICANT CERTIFICATION which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply with I understand my plans shall be used as public records.
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10255 Anthony pi DATE: 1112112013 REVIEWED BY: Mendez
APN: BP#: 'VALUATION: 1$12,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE: A
WORK install solar panels ate sfdwl rooftop, 8 panels, 2.1 kw
SCOPE
Ltech, flan Check PluwL Plum Cheek E'lec..Plun Check
Nkah. Perlin!Fee: Plumb. Permit Fee: Elec. Permir Fee:
Orher hlech. Insp. Other Plumb Insp. Li I Ocher Elee,Insp. Li
Alech. Insp. Fee: Plumb. Insp,Fee: Elco.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolulion 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $229.00 1PHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conslr uction Tax: T-1
Administrative Fee:
Work Without Permit? Yes Q No $0.00
Advanced PlanningLee.-ee: $0.00 Select a Non-Residential Q
Travel Doe- mentation Tees: Building or Structure �
Strong Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $2.20 $229.00 TOTAL FEE: $231.20
Revised: 10101/2013