13050074I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 LANSDALE AVE CONTRACTOR: CLEAN SOLAR PERMIT NO: 13050074
OWNER'S NAME: JUSTIN HO 1445 KOLL CIR STE 109 DATE ISSUED: 05/09/2013
OWNER'S PHONE: 6505042372 SAN JOSE, CA 95112 PHONE NO: (408) 217-8876
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
License Class IC10 jC4ty Lic. # �"C1 l b b 4-"I
J �
Contractor �_l� i� ad J of 1_ fae dtl S 2
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 peinalty 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 regulations per the Cupertino Municipal Code, Section
9.18.
Signature L �"Date
❑ 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)
I, 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.
ISignature Date.
INSTALL 16 PV PANELS ON (E) SFDWL ROOFTOP 4 KW
Sq. Ft Floor Area: Valuation: $17155
APN Number: 36912002.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN J80 DAYS OF PERMIT ISSUANCE OR
180 DA F OM LAST CALLED INSPFfCTION.
Issued by: Date: 5
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, Sectio ss�2�55005�,?5533, nd 25534.
Owner or authorized agent C ���/�J"� Ld �i�.� Date:
CONSTRUCTION L NDING 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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
WDRESS: 10450 LANDSDALE AVE DATE: 05/09/2013 REVIEWED BY: MENDEZ
N: BP#:��!`� *VALUATION: $17,155
,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION SOLAR -RES
USE: SFD or Duplex PERMIT TYPE:
WORK INSTALL 16 PV PANELS ONE SFDWL ROOFTOP 4 KW
SCOPE
No7E: 7hts esttnlate hoes not lnctuae jeer uue w o811e. Lcy.......�.N �...-. _ ....••• a, - ___ ___ .. _ - _ ,
. _ .. .. . __ ___... _.. .; E i'„N/..../ /Aa non/ fnr addn'I info.
District, etc.). These fees are basea on me rennunar
FEE ITEMS (Fee Resolution 11-053 E/f. 711/121
Xrech, Plon C.lwck
Pl:urrb. Platt Check
77[1"11C
1tcch. Pernrrl Fee:
Phnnh. PeErmit Fee:
PelMi7 PCe:
Oilier rllech. Insp.
Other 111111) h7sp.
Other Elec. Insp.
.11<ech. hrsp. Fce:
Plrrnrb. hap. Fee:
it
Eke, lay, Fee:
Fire QnNi/n Ml .00l1JOr DktrieL School
No7E: 7hts esttnlate hoes not lnctuae jeer uue w o811e. Lcy.......�.N �...-. _ ....••• a, - ___ ___ .. _ - _ ,
. _ .. .. . __ ___... _.. .; E i'„N/..../ /Aa non/ fnr addn'I info.
District, etc.). These fees are basea on me rennunar
FEE ITEMS (Fee Resolution 11-053 E/f. 711/121
tut orrnuit I NY.NN../
FEE
••••« ••• �-
QTY/FEE
--j •--- ---•---•---• ------
MISC ITEMS
Plan Check Fee:
$0.00
L_LJ #
$219.00
Alternative Energy System
1PHOTOVREs Photovoltaic System
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T=
Constt iclion Tax:
Adinhiistrative Fee:
0
Work Without Permit? ®Yes Q) No
$0.00
Advanced Planning Fee:
$0.00
Select allon-Residential
Building or Structure
0
T-(wel Doclnn0710tiorl Fees:
Strong Motion Fee: IBSEISMICR
$1.72
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.72
$219.001 TOTAL FEE:
$221.72
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