11110032CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23667 BLACK OAK WAY
OWNER'S NAME:
LUIS OBISPO, CA 93401
PHONE NO: (888)657-6527
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB f
MECH F RESIDENTIAL r COMMERCIAL f-
JOB DESCRIPTION: ADD PANELS TO EXISTING SOLAR (12) 2.64KW
Sq. Ft Floor Area: I Valuation: $14000
APN Number: 34256041.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 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 a inspection, I agree to emove all new materials for
inspection.
Signature of :
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.
AGENCY
I hereby affirm that there is a construction lending agency for the performance of "ork'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.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
iAlADDRESS:
23667 black oak wy
DATE: 11/07/2011
REVIEWED BY: larry s
APN:
BP#:
"VALUATION: 1$14,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR -
PERMIT TYPE:
WORK
add anels to existing solar (12).
SCOPE
It. plvrt Ch>•7;k F'ira (.ttc«k
i:'. .. .. x�:'.,; •. iii tf.=1 I�i:i11Jr:'S'•. ';� f. ':... ,.;: I.
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 nrelininary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711'11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$214.00
Alternative Energy System
/PHOTOvRES Photovoltaic System
Suppl. PC Fee: Q Reg. () OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. FeelD Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
4c'lrPliftl:l'1! i .ii r
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Pianni.na Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
A
Strong Motion Fee: IBSEISMICR
$1.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.40
$214.00
TOTAL FEE:
$216.40
Revised: 10/01 /2011