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12100043CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7736 OBSIDIAN CT OWNER'S NAME: If( LICENSED CONTRACTOR'S DECLARATION License Class C lb,. rj Lic. a �� �11-7 Contractor ft A Date 1 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 tbat 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 t`h�work for which this permit is issued. 1I _ 1 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. Additionajy, the applicant understands and will comply with all non -point source regulal' s per the Cupertino Municipal Code, Section 9.18. Signature )� Date 0�')I ❑ OWNER -BUILDER DECLARATION I 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) 1, 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 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 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. CONTRACTOR: PETERSEN-DEAN INC PERMIT NO: 12100043 7980 ENTERPRISE DR DATE ISSUED: 10/08/2012 NEWARK, CA 94560 PHONE NO: (510)494-9982 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALL ROOF MOUNTED SOLAR 3.33KW, 18 SOLAR PANELS AND NEW SUB -PANEL Sq. Ft Floor Area: I Valuation: $15000 APN Number: 36218025.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FR7ST CALLED INSPECTION. /p 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 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 1 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 I store or handle hazardous material. Additionally, should I use, quipment or devices which emit hazardous air contaminants as defined b the Bey Area Air Quality Management District I will maintain compliance wolfthe Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code ctions 25505, 25533, and 25534. Dater CONSTRUCTION LENDING AGENCY 1 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional Fm_� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7736 Obsidian Ct. DATE: 10/08/2012 REVIEWED BY: RDW APN: BP#: *VALUATION: 1$15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? - Yes . No OTC. 0 Yes © No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK mounted solar - 3.33 kw, 18 solar panels and new sub -panel. SCOPE [tsrroof OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 1$0.00 $0.00 MECH, HOURLY O Yes O No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No j:l: I h. Man c ';:. cbI r Phullh. Plun Chr, .6 Elec. Plan Check 0.0 hrs $0.00 Wee 'I. Purmil I 'r: P limb. Pc.'.�ir Fcc. Elec. Permit Fee: IEPERMIT Onccr Vc, h. Imp (Jlhrl 1;.,;,. Ire,;'. Other Elea Insp. 0.0 hrs $45.00 Ale(h. /n•!). F ..r•. Plun,h. hop. Insp. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These lees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn7 into. FEE ITEMS (Fee Resolution 11-053 Eff 7/l/ll) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $219.00 Alternative Energy System /PHOTOVRES Photovoltaic System Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 amps $45.00 Electrical IERT<200 Services Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Cnrt,�tructiuu TOX. Administrative Fee: 0 0 Work Without Permit? O Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 1 0 i Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISAfICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $92.50 $264.00 TOTAL FEE: $356.50 Revised: 10/01/2012