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12030051CITY OF CUPERTINO BUILDING PERMIT TE BUILDING 'S DECLARATION F_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_— Lic. # Contractor Date 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. APPLICANT CERTIFICATION I certify that l 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. MECH F RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: INSTALL ROOF MOUNTED SOLAR SYSTEMS(4 MODULES) 3.OKW 7/30/2012 -REV#1 ADD (4) ADDITIONAL MODULES AND REVISE INVERTER TO SWR 2500-US(SUNNY BOY) -REV# I ISS'D 7/30/2012 Sq. Ft Floor Area: I Valuation: $3000 APN Number: 36227008.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date I Issued by: ❑ 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 l 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 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. Owner :�3 V /2_ 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7611 SQUIREWOOD WAY CONTRACTOR: TOP CONSTRUCTION PERMIT NO: 12030051 OWNER'S NAME: BAYFIELD, CO 81122 PHONE NO: (408) 892-3449 ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # MECH F RESIDENTIAL F COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL ROOF MOUNTED SOLAR SYSTEMS(4 MODULES) (commencing with Section 7000) of Division 3 of the Business & Professions "SEE NOTES" 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. Sq. Ft Floor Area: Valuation: $2800 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 permit is issued. APN Number: 36227008.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: sJ��(1/ �TGI�l Date: Signature Date OWNER-BUILDER.DEC.LARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) 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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. 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 I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. 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 LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mrk's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date 6// X", / `L- FM-71 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7611 Squirewood Way DATE: 07/30/2012 REVIEWED BY: Sean OMNI APN: BP#: 12030051 'VALUATION: $200 PERMIT TYPE: Building Permit PLAAll ' CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES I PERMIT TYPE: WORK Revision #1: Add 4 additional modules and revise inverter to SWR 2500-US(Sunny Bo SCOPE Pliiiuh. Plum ( 'hv , „ la%'e' 'iH (1: a:7C phallb. Permit I-ce. l',IC(.'. Penn,., ��(IICf' .'! r['"; t:. lFj•S'f�. 0/b r Plurnh hv:p. A 0(.hu` %' ic(. l#!sp- NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These Pees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes Q No $0.00 hours $0.00 Plan Check, Hourly Photovoltaic System Suppl. PC Fee: Q Reg. 0 OT 0.0. hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()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: $0.00 (.'r7usweic°rion 1-0-Y. Adiniiiistrarive Peer: Q 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 1 hours Inspections $133.00 ISTINSP Inspection, Hourly E) ©� / ;� c�f Docrur;E�rrturir�it f ���°s: Strony- Motion Fee: IBSEISMICR $0.5 Select an Administrative Item / Bldg _Stds Commission Fee: IBCBSC SUBTOTALS: :::A $133.00 TOTAL FEE: $134.50 II Revised: 07/01/2012 RR7"'�� CITY OF CUPERTINO 2 FF,F, ESTIMATOR — BUILDING DIVISION 61 ADDRESS: 7611 Squirewood Way DATE: 03/12/2012 REVIEWED BY: Sean APN: a e� BP#: VALUATION: 1$2,800 ' PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK Install roof mounter solar systems 4 modules. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt. otr- L Thoco fooc aro hacod nn tho nroli►winary infer► atinn availahlo and nro anly an oclimmo_ Cnnlarl lho none fnr addn'I infa- FEE ITEMS (I ee Resolution 11-053 E . 7,111111 /1 FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 F 1 # $214.00 Alternative Energy System IPHOTOvRES I Photovoltaic System Suppl. PC Fee: :: Reg. 0 OT 0.0 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 _T_T G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $214.00 TOTAL FEE: $215.50 Revised: 1 /19/2012