12010092 (2)I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10730 ORLINE CT I COMPANYT E SOLAR I PERMIT NO: 12010092
OWNER'S NAME: WONG
VALLEY, CA 94546 PHONE NO: (510) 214-9005
LICENSED CONTRACTOR'S DECLARATION F_ i—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C-q Lic. M S &(o l
Contractor NE 96G1I0Q 04;[2Jrt1�LDate 011<6 Azal
1 hereby affirm that 1 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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 ay accrue against said City in consequence of the
granting of this pe ion I , the plicant understands and will comply
with all non -poi sour
Date
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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, and 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).
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
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 [hat 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 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,
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 I —RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: INSTALL ROOF MOUNT PHOTOVOLTAIC SYSTEM
Sq. Ft Floor Area: I Valuation: $24000
APN Number: 35922057.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHINO S OF PERMIT ISSUANCE OR
180 DAY LAST CALLED INSPECTION.
Issued by:
Date: / f Z4-
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 BF,"f I'ER
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. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should 1 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
CONSTRUCTION LENDING AGENCY
I hereby affirm that [here is a construction lending agency for the performance of
work's for which [his 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 Profess
Si
CITY OF CUPERTINO
Fm-77- FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10730 Orline Ct
DATE: 01/12/2012
REVIEWED BY: jsg
APN:
BP#: /� v� Os
"VALUATION:
1$24,000
'zPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
wORK
Install roof mount photovoltaic system
SCOPE
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 oniv an estimate. Contact the Dent for addn 11 info.
FEE ITEMS (lee Resolulion .1.1-053 Eff 7/Z-11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 1 1#
$214.00
Alternative Energy System
1PHOTOVRBS Photovoltaic System
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feels Reg.
® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? ® Yes Q No
$0.00
Advanced PlanninE Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
Strong Motion Fee:
IBSEISMICR
$2.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.40
$214.00
TOTAL FEE:
$217.4