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13100072 MY OF CU P]E][8UNO BUMI DE NG ]PIERMffT BUIILDING ADDRESS: 11518 CHARSAN LN CONTRACTOR:SOLARCITY PERMIT NO: 13100072 OWNER'S NAME: SU PHILIP AND CHEN MICHELLE MEI LIE 3055 CLEARVIEW WAY DATE ISSUED: 10/10/2013 OWER'S PHONE: 5105790049 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Lic.# �6INSTA]L]L PV SYSTEM ON ROOFTOP 8 PANELS,2]KW Contractor Date [0/10/13 I hereby affirm that I am lice, d under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&c 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:$8000 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:36210069.00 Occupancy Type: permit is issued. APPLICANT CERTIFICA'T'ION I certify that 1 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 ���®�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 DA OMI]LAST CALLED )INNSPE TION. 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 Issued by: Date: �/ a non-porn u ations per t r upertino Municipal Code,Section .18. / RE-ROOFS: Signatur Date b f / 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 I hereby affirm that I 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 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&c 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&c 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 Cu ertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&r Safety C , ections 20",and 25534. Section 3700 of the Labor Code,for the performance of the work for which this I Owner or auth permit is issued. a ate: I certify that in the performance of the work for which this permit is issued,l 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,l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must l 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.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 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 cCRTY OF cCUPER TING FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 11518 charsan In DATE: 10/10/2013 REVIEWED BY: Mendez APN: IBP#: OOO�A *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: SOLAR-RE WORD install pv system on rooftop 8 panels, 2kw SCOPE lfech. flan Check Phimb. Plan C'ltctc`k Stec.Plan Check Xfech. Permit Fee: Plumb. Permit Fee: Eter... Pcrmir Tee: Other Afech.Insp, . Other Plumb Insp. C Other Elec.Insp. Lj ,Vcch.Insp. Fee: Plumb. Insp.Tee: Eley.Imp,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 on! an estimate. Contact the De t or addn 7 in o. FEE ITEMS(Fee Resolution 11-053 EfT 7/1113) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. FeeQ Reg. OOT 0.0 hrs PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tarr: C Adininistrative Fee: Work Without Permit? 0 Yes (D No $0.00 1 E) Advanced PlanninL Fee: $0.00 Select a Non-Residential E) Travel Docznnentalion Fees: Building or Structure 0 Strong; Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 Ll SUBTOTALS: $1.80 $229.00 TOTAL.FEE: $230.80 Revised: 10/01/2013