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11110112CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10978 SYCAMORE DR CONTRACTOR: TOUCAN CONSTRUCTION PERMIT NO: 11110112 AND SOLAR INC OWNER'S NAME: SAN BRUNO, CA 94066 PHONE NO: (650) 588-2480 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r 1Dr C� � d � License Class ��' Lic. {f r" r— Contractor %OJG�/✓ COBS F _ Date I 2 1 2-0 11 MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL SOLAR PANEL AT EXISTING SFD (commencing with Section 7000) of Division 3 of the Business & Professions ROOFTOP, ROOF MOUNT SOLAR ARRAY, 35 PANELS/UNITS, 8.4 Code and that my license is in full force and effect. KW 1 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 Sq. Ft Floor Area: Valuation: $49500 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number: 34256032.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Ily, the applicant understands and will comply with all non -poi urce regulati s per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Sign Date 411a o V Issued by: Date: ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. 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 1 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. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the ' forthwith comply with such provisions or this permit shall be deemed revoked. Date: �� a APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I 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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FM,_ I FEE ESTIMATOR - BUILDING DIVISION � X X� c)\ \2,--- ADDRESS: 10978 sycamore dr. DATE: 11/21/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$49,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK install solar panel at existing sfd rooftop. SCOPE r +,tr: i'h�•.: ,, r'/c:r i �etYt ;: � L;lcta•. I ,tr++ � ...., r NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the Drelinsnary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS flee Resolution II-053 E. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1-1 # $214.00 Alternative Energy System IPHOTovRES Photovoltaic System Suppl. PC Fee: 0 Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 A Strong Motion Fee: IBSEISMICR $4.95 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC 1 $2.00 SUBTOTALS: 1 $6.95 $214.00 TOTAL FEE: 1 $220.95 Revised: 1010112011