13100122 CETY OF CU PIER'1I INO WELDING PERMIT
BUILDING ADDRESS: 10700 MERRIMAN RD CONTRACTOR:PROVOLTZ INC PERMIT NO: 13100122
OWNER'S NAME: CHU JOLI AND LEE HSUAN-CHUNG 1246 SANDRA DR DATE ISSUED: 10/17/2013
OWNER'S PHONE: 4088738783 SAN JOSE,CA 95125 PHONE NO:(408)265-8658
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LY—
License Class Lic.# f f l Zor—t UNIT B-INSTALL ROOF MOUNTED IPV SYSTEM 12
IPANELS,
Contractor Date IU— 14--(]) 3.0 KW
II hereby affirm that II 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:
1 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:$15000
ave 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:34216101.00 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 �S®����®�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 DAYSROM(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 /Q 7
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-poi ource regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur Date `0 13-13 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
II 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
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)
I,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 Co ection8 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authori agent: Date:
1 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,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
1 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
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
MY OF cCUP ERUNO
]FEE IESTEMATOR— BUELIDINO DIVISION
ADDRESS: 10700 merriman rd DATE: 1 011 71201 3 REVIEWEID BY: Mendez
APN: BP#: 3 �� `VALIDATION: 1$15,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RE
USE: pPERMIT TYPE:
WORD install roofmounted pv system 12 panels, 3.0 kw
SCOPE
Ltc<clr: PlanC"heck Plumb. Plun CheekElec..Plan Check
Xlech. Permit Fee Plarmb, Permit Fee: F,lec. Permit Fee:
Other hfech.Insp. l Other Plumb Insp. Other Elec.Insp.
rllech.Insp. Fee: Plumb, hrsp. Fee: Elec.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 endiLhtinq information available and are onl an estimate Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $229.00 /PHOTovREs Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl, Insp. Feer Reg. OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consltztction Tax:
Administrative Fee:
Work Without Permit? 0 Yes (0 No $0.00
Advanced Planning Fee: $0.001 Select a Non-Residential
Trcn,el Docianentation Fees: Building or Structure
a
Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item
Bld&Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 11 $2.50 $229.001 TOTAL FEE-T $231.50
Revised: 10/01/2013