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13050193CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10846 LINDA VISTA DR CONTRACTOR: CALIFORNIA SOLAR PERMIT NO: 13050193 SYSTEMS OWNER'S NAME: ANAT-GILLER SACHS 1511 E ORANGETHORPE AVE STE D DATE ISSUED: 05/28/2013 OWNER'S PHONE: 4082534543 FULLERTON, CA 92831 PHONE NO: (800) 324-1978 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] ❑ LICENSED CONTRACTOR'S DECLARATION . J INSTALL 15 FLUSH -MOUNTED PV PANELS (3.67SK License Class. `raV ' = Lie. #1 Date Contractor 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 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 Valuation: $30000 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 35614049.00 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 IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAY AST LED INSPECTION. 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 ued by: 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. f . r r l -- Date r"� RE -ROOFS: All roofs shall a inspected prior to any roofing material being installed. If a roof is Signature / 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 Code, Section 25532(a) should I store or handle hazardous declarations: I have will maintain aCertificate of Consent to self -insure for Worker's Health & Safety material. Additionally, should I use equipment or devices which emifhazardous and 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. will maintain the Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Owner or authorized agent: � � t 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, l Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of become subject to the 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, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. costs, 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 CITY OF CUPERTINO it 1171PI . IP QTIM A TOR — RIMMING DIVISION NOTE: This estimate does not include fees due to other Departments (he. Planning, Public PrurRJ', *'ere, ouinrury our—, �suuru, �.�.• _.r. _-a.....*..--.:uf-v-.-O;n.... anahto a"li aro army ati ovii»tate_ Contact the Debt for addn'l info. District, eIA . hese ees tire uu vn urc �.,..r...... FEE ITEMS (Fee Resolution 11-053 Eff- 7/1/122 DDRESS: 10846 LINDA VISTA DR DATE: 05/28/2013 REVIEWED BY: MELISSA IWAPN: 356 14 049 BP#: , j C7) ` *VALUATION: 1$30,000 *'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Dec. Lisp, Fee: PENTAMATION SOLAR -RES PERMIT TYPE: USE: PME Plan Check: WORK INSTALL 15 FLUSH -MOUNTED PV PANELS 3.675kW SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (he. Planning, Public PrurRJ', *'ere, ouinrury our—, �suuru, �.�.• _.r. _-a.....*..--.:uf-v-.-O;n.... anahto a"li aro army ati ovii»tate_ Contact the Debt for addn'l info. District, eIA . hese ees tire uu vn urc �.,..r...... FEE ITEMS (Fee Resolution 11-053 Eff- 7/1/122 Xlech, Noii Check Plumb. Phm Check Elec. Pian Che( �bfeclt. Permil Fee: Phlnxb. Pe»nit Fae; Stec. Permit /-Cc: Outer hlech. h7sF?. Other Phnnb hash. Other Elec. Insp. Akch. Insp. pore: Plumb. Insp, Fee: Dec. Lisp, Fee: lu's $0.00 PME Plan Check: NOTE: This estimate does not include fees due to other Departments (he. Planning, Public PrurRJ', *'ere, ouinrury our—, �suuru, �.�.• _.r. _-a.....*..--.:uf-v-.-O;n.... anahto a"li aro army ati ovii»tate_ Contact the Debt for addn'l info. District, eIA . hese ees tire uu vn urc �.,..r...... FEE ITEMS (Fee Resolution 11-053 Eff- 7/1/122 ............................._ FEE .-•-•- --- _ QTY/FEE _--- ---- --- MISC ITEMS Plan Check Fee: $0.00 L J # $219.00 Alternative Energy System IPxoTovREs Photovoltaic System Suppl. PC Fee: (j) Reg. () OT [61A .0 lu's $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OTQ,0hrs $0.00 PME Unit Fee; $0.00 PME Permit Fee: $0.00 C017S17'11ch017 hill": _TT Acltniiiistrative Fec: Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure G 0 Tiywel Docannenlotiort Fives: Strong Motion Fee: IBSEISMICR $3.00 Select an Administrative Item B1dy- Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: ` $5.00 $219.00 TOTAL FEE: $224.00 ' Revised: 04/29/2013