12070255CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 MIRA VISTA AVE
CONTRACTOR: SOLARCITY
PERMIT NO: 12070255
OWNER'S NAME:
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clas Lic. #_�
MECH RESIDENTIAL COMMERCIAL
Contractor AE4&IT74 Date 1 %-+
I hereby affirm that I am licen d under the provisions of Chapter 9
JOB DESCRIPTION: INSTALL NEW SOLAR HEAT PUMP, BASEMENT' DUCT'
(commencing with Section 700 of Division 3 of the Business & Professions
REPLACEMENT, ATTIC AND CRAWLSPACE INSULATION.
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
Sq. Ft Floor Area:
Valuation: $30500
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 35704028.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point the ertino Municipal Co , Section
9.18.
Signature Date /
Issued by• Date:
❑ O R-BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE,
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, ons 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
CONSTRUCTION UNDING AGENCY
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of'work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
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
ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
II FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10500 mira vista ave.
DATE: 07/31/2012
REVIEWED BY: bobs.
RMN
APN:
1 BP#: �Cl a S
*VALUATION: 1$30,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
install new solar heat pump,basement duct replacement, attic and crawls ace insulation
SCOPE
Mech. Plan Check T77hrs $0.00
Purr+dl) f trrrr t fieo'•
Elea Nan L'heck
Mech. Permit Fee: IMPERMIT
l7•1, ' Pr C
I tCL Pel- it RV,
Other Mech. Insp. 0.0 hrs $45.00
n,<<<r flivarb h,,, !_
Chl,cr ?' _�_ fmp, Ll
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Plum), h.Vp, Fue..
p"C".
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 preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F__17 #
$102.00
Alternative Energy System
ISOLWATE Solar Water Heater
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
F-1-1 #
$67.00
Mechanical
IMRRAA Heating System
Permit Fee: Hourly Only? (F) Yes Q No
$0.00
Suppl. Insp. Fee-.0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
I--'W-lifM 7JC.
Administrative Fee: IADMIN
$42.00
Q
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannin& Fee:
$0.00
hours
$133.00
Inspections
ISTINSP Inspection, Hourly
0
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$3.05
Select an Administrative Item
Bldy Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$137.05
$302.001
TOTAL FEE:
1 $439.05
Revised: 07/01 /2012