11050060CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7408 ROLLINGDELL DR
OWNER'S
Pf LICENSED CONTRACTOR'S DECLARATION
License Class-
-Q L LI& Lic. # QZ)D 732-
Contractor [�Q�^5�+� V �rnn t✓oIate
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
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. , v
APPLICANT CERTIFICATION I`
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 ;/ Date s Jo t(
❑ 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.
CONTRACTOR: I PERMIT NO: 11050060
wn V V ii(< S I DATE ISSUED: 05/10/2011
PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: INSTALL SOLAR PANELS AT SFDWL ROOFTOP
**SEE NOTES"
Sq. Ft Floor Area: I Valuation: $18000
APN Number: 35931039.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY Fr, M LAST CALLED INSPECTION.
Issue Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg 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, 255339 and 25534.
Ow_ : S 1 t
� Date: J
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of murk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
REVISION #
CITY OF CUPERTINO BUILDING PERMWE �'- t
BUILDING ADDRESS: 7408 ROLLINGDELL DR CONTRACTOR: SUN WORK RENEWABLE PERMIT NO: 11050060
ENERGY PRODUCTS
OWNER'S NAME:
PALO ALTO, CA 94306 PHONE NO: (650) 520-9918
❑ LICENSED CONTRACTQOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C�4 (o Lic. # -` Z 01 ! Z
n MECH r RESIDENTIAL r COMMERCIAL r
Contractor 1LGn --n L4,A Date 6 / l ( (
1 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
performance of the work for which this permit is issued.
JOB DESCRIPTION: INSTALL SOLAR PANELS AT SFDWL ROOFTOP
5/23/201 I -REV# I -REVISE GRID TIE ADD NEW ADDITIONAL -(o/,/i e,, ¢ j
l have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area:
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. 1 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.
�
��� �/ Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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.
APN Number: 35931039.00
Valuation:$18000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
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, 25533, and 25534.
— Date: a / /
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork'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.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7408 rollingdell dr.
DATE: 05/23/2011
REVIEWED BY: bobs.
APN:
BP#:
'VALUATION: j$1,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
revise qrid tie add new additional solar panels.
SCOPE
pnif 1.
Li
NOTE. These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef. . 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
0 hours
$126.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg, 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i S fin". O'r,(cli ; Ta v
Acoustical Fee: 0 Yes (D No
$0.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure 0
,;•rrt'r'I /ir3r•trrrfcwlrIlion
Strong Motion Fee: IBSEISMICR
$0.50
0.5 hrs
$39.00
Admin./Clerical Fee
1ADMIN
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$1.501
$165.00
TOTAL FEE:
$166.50
Revised: 03/01 /2011
�CITY OF CUPERTINO
WN FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7408 Rollingdell Dr
DATE: 05/10/2011
REVIEWED BY: Mendez
APN:
BP#:
"VALUATION:
1$18,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
Install solar panels at sfdwl rooftop
SCOPE
NOTE: These tees are hared on the nreliminary Information available and are only an estimate. Contact the Dent for addn'1Info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$207.00
Photovoltaic System
ISOLARRES
Suppl. PC Fee: G Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee4S Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Plg: Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
lrr�allir3r.rrr�Erntrti%}irF'G��.
Strom Motion Fee:
IBSEISMICR
$1.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.80
$207.00
TOTAL FEE:
$209.80
Revised: 04/29/2011