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13040077CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10601 N BLANEY AVE CONTRACTOR: FREEDOM SOLAR INC I PERMIT NO: 13040077 OWNER'S NAME: PENINSULA BIBLE CHURCH INC OWNER'S PHONE: 4082027870 ❑ LICENSED CONTRACTOR'S DECLARATION License Class21106172 _ Lic. # / Contractor / yZ-)l1 60%' Date i I hereby affirm that I am licensed under the provisions of hapter 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 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 permit is issued. APPLICANT CERTIFICATION 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 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 with all non -point source re ations per the Cupertino Municipal Code, Section 9.18. SignaturDate��7�?� ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 845 S MCGLINCY LN I DATE ISSUED: 04/23/2013 CAMPBELL, CA 95008 PHONE NO: (408) 613-2300 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALLATION OF ROOF MOUNTED PV SYSTEM 25.53 KW, ADD SUB PANEL 125 AMPS Sq. Ft Floor Area: I Valuation: $101210 APN Number: 31602085.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1SA A S OIL ST A-VED INSPECTION. RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, S , and 534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature' Date CITY OF CUPERTINO FFX FRTIMATOR — BUILDING DIVISION ADDRESS: 10601 N BLANEY AVE DATE: 04/09/2013 REVIEWED BY: MENDEZ APN: BP#: o f *VALUATION: $101,210 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building g PENTAMATION SOLAR-COMM PERMIT TYPE: A USE: WORK INSTALLATION OF ROOF MOUNTED PV SYSTEM 25.53 KW SCOPE ikfedi. Plan Check Plumb. Pko1 Chec% Elec. Plan Check 0.0 hrs $0.0- ,�dec11.'Permit Fee: Plrnrib. Permit Fce: Elec, Permit Fee: IEP..ERMIT 01h, illech, fi�sj�. Other Phnnb Insp, Other Elea Insp. 0.0 hrs $45.00 Akch. Insp. Fee: Phmih. Insp. Fee: Elec. Insp, Fee: NOTE: This estimate does not inetutteJees aue to orner ueparrmenrs (l.G rulrlrung, rKUlll I.V,OJ, L „......r —, - r',..,r....i�r.oPanfFnrnddn°linfn- 1J{slrll;l, el" . 11Ie3G Gea !!,G ul,JGu v,....G . ca.+..a....s Y... FEE ITEMS Lee Resolution 11-053 Eff. 711112) ... .. v......•.............- FEE ..--.- --- - QTY/FEE ---- ---- --- MISC ITEMS Plan Check Fee: $0.00 I ' kW $532.00 Alternative Energy System 1PHoTovcoM Photovoltaic System- Suppl. PC Fee:- Q Reg. () C 0,0 hrs $0.00 PME Plan Check: $0.00 125 1 amps $45.00 Electrical IBELEC2oo Services Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 T7=_ PME Unit Fee: $0.00 PME Permit Fee: $45.00 Consli- fiction T4.7x: J-1 Administrative Fee: IADMIN $42.00 Work Without Permit? Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure., Travel Documentation Fee: ITRAVDOC $45.00 Strong_Motion Fee: IBSEISMICO $21.25 Select an Administrative Item; B1dg,Stds Commission Fee: 1BCBSC $5.00 SUBTOTALS: $158.25 $577.00 TOTAL FEE: $735.25 Revised: o4/u1/Zu16 845 S. McGlincy Lane Campbell, CA 95008 (408) 613-2300 April 9, 2013 City of Cupertino Permit Department RE: Freedom Solar, Inc —Authorization Please accept this document as a Formal Authorization allowing Rich Moore, Marina Zierk, Bryan Whitton, Michael Copeland and Catherine Zier_k_to act as an Authorized Agent to sign for, and pull permits. If you have any questions, please contact our office at (408) 613-2300 Regards, Bryan Whitton Freedom Solar, Inc. (408) 600-8521 cell