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14010051CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10271 JOHNSON AVE CONTRACTOR: SOLARCTTY PERMIT NO: 14010051 OWNER'S NAME: JASON PARK 3055 CLEARVIEW WAY DATE ISSUED: 01/08/2014 OWNER'S PHONE: 6507937496 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL (1_v{ �J R INSTALL 9 ROOFTOP, FLUSH MOUNTED PV PANELS License Class Lic. # (�ld Ijj (2.25KW) � Date 1 Contractor GJ_ I hereby affirm that I am lice d under the provisions of Chapter 9 (commencing with Section 700 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 Sq. Ft Floor Area: Valuation: $9000 of the work for which this permit is issued. 5erfionnance ave and will maintain Worker's Compensation Insurance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this APN Number: 37518030.00 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. 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 F LLED 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 d by: Date: f g granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 y RE -ROOFS: Signature Date 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 Law for one of 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 (See. 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. 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 & 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 th Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec ons 5505,25f33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 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, 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 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 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 PERMITS View Properties: Primary. 10271 JOHNSON AVE CUPEFMNO CA 95014 (375 18 030) Issued PL-rrrdt #- 114010051 Status: lExpired Permit App #t 114010051 SuIxTittal Date. 101/07/2014-----] Issue Date: 101/08/2014 Last Inspection: B#ration Date: Permit Type: SOLAR -RES Permit SLd)cases: Nb configured subcalses. Project Valuation: I gow.66 Date Closed: I I Scope of Work: MTALL 9 ROOFTOP, FLUSH NOU D PV PANELS (2.25KW) k- IVO INSPec,-6tOnS C/V i�Ljs4et" Vn Permits (14010051) Fee C har ges (3) Con t ac ts 12 Applicant JASON PARK 10271 JOHNSON AVE CUPERTINO, CA 95014 Email: M Property Owner JASON PARK 10271 JOHNSON AVE CUPERTINO, CA 95014 Email: Contractors (1) Date Exp: 03/31/2016 Status: Active Contractor #: 28844 State License #: Contractor Type: CONTRACTOR - SPECIALTY Properties (1) [375 18 030] 10271 JOHNSON AVE CUPERTINO, CA 95014-3811 Water SAN JOSE WATER Service Area SERVICE Eichler Home No Sanitary SUNNYVALE SANITARY District DISTRICT Land Use Res 1-6 Rancho Seismic Zone Valley Floor Lot Area 5700 HOA No Neighborhood! Flood Hazard D Zone Zoning R1-5 Maintenance 5 Zone Liquefaction No Area Annexation 1999-03-15 99-071 Info Cupertino 1999-03-01 Rancho Rinconada 98-09 School FREMONT UNION District (High School) School CUPERTINO UNION District (Elementary) Heritage No Trees Lot Type R1 Fire Severity No Zone Street Name JOHNSON Landslide No Area Documents (4) 0 03090028.pdf Remote Laserfiche file. uploaded on 0310812 018 ALTERNATIVE ENERGY PERMIT APPLICATION "J \mom COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION �� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �\ (408) 777-3228 • FAX (408) 777-3333 • buildino a cupertino.orq \� PROJECT ADDRESS APN9 OWNER NAME P EMAIL SV Y`M XV STREET ADDRESS .^� � �jn� I CITY, S TE, ZIP �^ � -41 FAX CONTACT NAME _^ PHC7 I ]\ E-MAIL f .� STREET ADDRESS '" CITY, ST t FAX ZIP ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR &ONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME///�� LICENSE NUMBER v O I O ! t LIC ENS ^ YPE c COMPANY NAME 3olos i(s C' E-MAIL SS ^ ` c� (r SDlcu �t Ltdrf, BUS. LIC 9 FIX STREET ADDRESS ) 1'�' _ (� �( CITY, STATE, ZIP y l PHO f - (# ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF WSFD or Duplex ❑ Multi -Family STRUCTURE. ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ No OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION To SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: H KILOWATTS: •_ '�/ Q � IdP n I TOTAL VALUATIOA p� cc DESCRIPTION OF WORK � � - so as - By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uilding constructi I authorize representatives of Cupertino to enter the above -id tified pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER a E^ ❑ EXPRESS U U ❑ STANDARD z: ¢j . ❑ LARGE MAJOR PVApp_2012.doc revised 06/20/12 F"_fto CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are only an estimate_ Cnntart tho l)ont for addn11 infn FEE ITEMS (Fee Resolution 11-053 Eff 711,113) ADDRESS: 10271 JOHNSON AVE DATE: 01/07/2014 REVIEWED BY: MELISSA L1ec;h. Perin Fee: APN: 375 18 030 BP#: `VALUATION: $9,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Ta J, I r'c': PENTAMATION SOLAR - PERMIT TYPE: WORK INSTALL 9 ROOFTOP FLUSH MOUNTED PV PANELS 2.25kW SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are only an estimate_ Cnntart tho l)ont for addn11 infn FEE ITEMS (Fee Resolution 11-053 Eff 711,113) ,Wch. flan Check 11hanb. Plan C::"hec.'k F71 Elec. flan (:;heck L1ec;h. Perin Fee: Plumb. Permit Fee: $0.00 Other h9ech. InspLi 01her Plumb Insp,Li Other 1`icc: Insp. Li 1Ic.'L'1' InS°t). t'6'e' Ta J, I r'c': t'('. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are only an estimate_ Cnntart tho l)ont for addn11 infn FEE ITEMS (Fee Resolution 11-053 Eff 711,113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $229.00 Alternative Energy System 1PxoTovREs Photovoltaic System Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT p p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ""j-,o,w,fion 1 W ; Adininistraytive .Fe?e: 0 G Work Without Permit? Yes (j) No $0.00 Advanced Plannin Fee: $0.00 Select a Non -Residential Building or Structure i 7'1-411 cel Doctimentutiolt �''' .>�: Strona Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.90 j $229.00 TOTAL FEE: $230.90 Revised: 01/01/2014