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12020073
I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10417 ANSON AVE I CONTRACTOR: SOLARC[TY I PERMIT NO: 12020073 1 OWNER'S NAME: License Class Lic. NCB `Q Contractor Date [ hereby affirm that [ am licensed 4inder 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. [ hereby affirm under penalty of perjury one of the following two declarations [ 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 wWdrit4is permit is issued. APPLICANT CERTIFICATION \ [ certify that [ have read this application and state that the above information is correct. [ 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, th applicant understands and will comply with all to 1 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, aid 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: [ 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. [ 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 periit is issued, I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 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 [ 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.[ 8. 3055 CLEARV[EW WAY DATE LSSUED: 02/17/2012 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 JOB DESCRIPTION: RESIDENTIAL Cl COMMERCIAL13 INSTALL SOLAR PANEL AT EX SFDWL ROOFTOP Sq. Ft Floor Area: I Valuation: $26500 APN Number: 32641001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA10 1710M LAST CALLED INSPE TION. Issued by: 7i1 G Dater �7 RE -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. if a roof is installed without first obtaining an inspection, [ 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 [ will maintain compliance with the Cupertin unici al Code, Chap er 9.12 and the Health & Safety Code, Sect• ns 5505, 33, an 25534. Owner or authorized agent: CONSTRUCTION LENDING AGENCY [ hereby affirm that there is a construction lending agency for the performance of work's for which this perinit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION [ understand my plans shall be used as public records. Licensed Professional Date CITY OF CUPERTINO BUILDING PERMIlReASION _ BUILDING ADDRESS: 10417 ANSON AVE CONTRACTOR: SOLARCITY DATE 3 OWNER'S NAME: SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. D INSTALL SOLAR PANEL AT EX SFDWL ROOFTOP Contractor e .S— — 7. 5/10/12- REVISION #1- REVISE WIRING TO REMOVE LOAD I hereby affir that I am sed under the provisions of Chapter 9 SIDE TAP, WIRING TO DISTRIBUTION PANEL, UPGRADE (commencing with Seetio 000) of Division 3 of the Business & Professions MAIN ELECTRICAL PANEL 200 AMP-ISSD 5/14/12 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: $27500 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 APN Number: 32641001.00 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 FROM LAST CALLED 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 Issued by: � Date: tands and will comply granting of this permit. Additio ally, Code, Section 9.18. RE -ROOFS: Signature 71-- 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 (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. 1 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 Qua ity Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertin Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, . Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized age 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 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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. Addition Ily, the a licant understands and will comply with all non -point sou regula s per a Cupertino M icipal Code, Section Licensed Professional 9.18. OF CUPERTINO W-CITYM FEE ESTIMATOR - BUILDING DIVISION ` ADDRESS: 10417 anson ave. DATE: 02/17/2012 REVIEWED BY: bobs. APN: BP#: /spa 00 73 "VALUATION: 1$26,500 I PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK install solar panel at ex. sfd rooftop. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School DictricL etc ►_ These fepc nre hacod on the nrolininnru infnrmatlnn avnilahle awl aro ontu an e_cllmaty_ Contact the Dent for addn'l info. FEE ITEMS (I,'ee ResOlUtiO17 11-053 B . 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 1-1 # $214.00 Alternative Energy System IPHOTOFRES Photovoltaic System Suppl. PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Plannine Fee: $0.00 Select a Non -Residential Building or Structure C) Strong Motion Fee: IBSEISMICR $2.65 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $4.651 $214.00 TOTAL FEE: $218.65 Revised: 1 /19/2012 Fm-7, CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10417 Anson Ave DATE: 05/10/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: j$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1REAP2 PERMIT TYPE: WORK Revision #1: Revise wiring to remove load side tap and wiring to distribution panel. Upgrade main SCOPE electrical panel to 200 amp. :lf3 Check phollb. Plum A Elec. Plan Check 0.0 hrs $0.00 Y1,1111 Pet -wit 1-ec" pb�., i'� ��,��ir F��e; Elec. Permit Fee: 1EPERMIT Other ikkch, Ins";. Chher Plumb bur).Li Other Elec. Insp. Ej �hrs$44.00 ,id,(r�. Invi). Fs phimi;. hap. Fee. Ve(.Insp. kcc. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 r 200-1 amps Electrical $44.00 1ERT1200 Services Suppl. PC Fee: (D Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 Cotis;,zrction Tax: Administrative Fee: IADMIN $41.00 Q E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential St Building or Structure G) 0t � Travel Documentation Fee: 1TRAVDOC $44.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 SUB'l['[TfALSc 1 $130.50 $44.00 TOTAL FEE: 1 $174.50 Revised: 04/01 /2012