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13100037 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 931 BLAZINGWOOD AVE CONTRACTOR:FUTURE ENERGY PERMIT NO: 13100037 CORPORATION OWNER'S NAME: MURAKAMI SAM S AND HIDEKO 310 PIERCY RD DATE ISSUED: 10/03/2013 OWNER'S PHONE: 4082534129 SAN JOSE,CA 95138 PHONE NO:(408)754-3744 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C''/U Li..# �`�3 7/�O ��ST�LL PV SYSTEM ON ROOFTOP 16 Pt�1V1G1L.5,31KW Contractor t�(l�U(�-L +�/-7=C VV Date` 0— 3 J /- 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. I Sq.Ft Floor Area: Valuation:$21250 jrhave 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:36920017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT IT]EX PSS IT WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN ll�®��®�PERMIT ISSUANCE ®� 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 llDA:7 ® LAST 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 /0 3 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per Owtupertino Municipal Code,Section 9.18. /Q_ Z ROOFS: Signatur �zAel� Dat J 6 All roofs shall be inspected prior to anyny roofing material being installed.if a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARA'T'ION I hereby affirm that T 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 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 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,Sections 2 553 ,and 2W4. Section 3700 of the Labor Code,for the performance of the work for which this y /O permit is issued. 3 Owner or authorized agent: ` Date /. 0 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,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 l have read this application and state that the above information is correct.l 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 l 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 MY ®IF CUPER ITNG FEE IESTMATOR- BUILDING DIVISION A DDRESS: 939 blasingwood dr DA'R'E: 10/03/2013 REVIEWEID BY: MENDEZ PN: BP#: / �� *VALUATION: 1$21,250 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 1PENTAMATION SOLAR-RE USE: pPERMIT TYPE: WORK install pv system on rooftop 16 panels, 3kw SCOPE F__ Afech. Plan Check Plumb. Plan Check Elec.Plan(:;heck Mech. Permit Fee: Plumb. Permit Fee: Glee.Permit 1;'ee: Other:L1ec•h. Insp. L] Other Plumb Insp. Ell Other Glee Insp. 0 Alech.lisp. Fee: Plunth, Insp. Fee: Elec.Insp. Fee: NOTE.This estimate does not include fees due to other Departments(L e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). TheseLees are based on the prelhiniina information available and are onl an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 ff 7/1/13) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1 # Alternative Energy System Suppl, PC Fee: 0 Reg. 0 OT Q,Q hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl, Insp. Fee-.0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction lax: Administrative Fee: Work Without Permit? () Yes E).No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Structure (��utiel Documentation Fees: Building � Strong Motion Fee: IBSEISMICR $2.13 Select an.Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.13 $229.00 TOTAL FEE: 1 $232.13 Revised: 08/01/2013