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BUU.DING.DIVSION PERNIIT
4a 2_
BUILDING ADDRESS:
FERMITNO.
1092 NOVEMBER
SOLARCITY
'
OWNER'S NAME:
PERMIT L95UE DAIS
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SA CONTROL NO.
ARCHTIECOENGINEER:
BUILDING PERMIT INFO
UPGRADE MAIN ELECTRICAL
eLDc ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
.SI
PANEL TO 200 AMP TO 2,p�®LIF15C17 tion
1 WMby amnia tat 1 w licensed under provisions of Chapter 9 (commarcing
p
wit Section 7001)) of Division 3 of She Business att Pr,feedoru Cods. arta my license i
••_�.. ..�...-...�... .___....... ... ... .
In full force and effect
Wanse Clan [ 4(y Gi 01R Lie,• d
Dam Spj31/.q¢^Con Sol
DELL
r - `� ARCHf1ECTS Dmlar. ON
I undsntanJ mY Plan„hall I e used u Public cnrt
Licensed Pmfesun al
OWNER•BUILDER DECLARATION
1 Wreby affirm that 1 am caempt fmm Mc Conu rel License Law for the
following Rmon. (Scotian 1101.5, Business and Professia. Code: Any city or county
which requites a Permit a construct altar. Impaw. demolish, m repair any stuctm
prior m its issuance. also requires to applicant for such Permit a Ek a signed statement
Mar he i, liecmadP.t m to P�MmAOf to cantr,etm•, Li OAAM l,w(ChaPW 9
Sq. Ft. Floor Area �
Valuation
(commencing with Section 1000) Of Division 3 of the Bond. and Profasum. Cade) or
tat he is exempt Merchant and She basis for dr, alleged eaempdon. Any violation of
APN Number
Occupancy T
P Y YPe
Section 103121 by arty applicant far a Permit Subjects to applicanua a civil penalty of
AM masa Man live DattRd dollars ($50DL
0 1, as Armor of Me property, a my coployeas with "gas u Meir sole eampemadon,
Required Inspections
will do to want And ts.cone me II MI Intended W offered for sale (Sec. 10(4. BnGaatt
and Profession, Code: The Cantmtaes U. Law dam rcl apply m an owner of
propertywbo Wilds a impasses IM+con.and who docaaN vmk him,elfmI gh his
own employees, provided that such improvements arc not imetttt moRertd for sale, If.
however. to building or improvement is Sold within arc year of completion. She mnar.
builder will have Me Mention of paving tat W did Out Wild a improve for purpose of
sale.).
0 I. es ownm of d o prepart, w exclusively conbxting with flamed contractors to
constaset to project (sae 10,4. Business anti Pro emons code:) The eonvacwrs U.
Cense Law does nut apply m an owner of property who Wilds or mr,wo et temoo. Nd,
who contraeu for such projects with a cOnVacmr(s) licensed par9Yn1 m Ole ConVCloYa
Liamme law.
❑ I are aempt under See • B h P C fm ti, recon
Ow er Data
WORKER'S COMPENSATION DECLARATION
1 hemby sill. under penalty of perjury, arc of to fallowing declarm mtc
1 ha.e and will maintain a Certificate ofCunscat to self-insum for Worker, Compete
ma, as provided fm by Section 3100 a Me labor Code. has to perfomana of Me
work fm which Mu permit u issued.
I have And will co.hu In Werlme. CampmWJan Inmemee. roe R9YIRd by Sectm
100 of Me labor code. fm the performanrc mfte work for whim to permit 1, ust ed.
.
My Wmkofs Compeaaa6on buurana card. and Polity number arc:
Camer.7>.. YI Gh /a!Y)P,Vt 0011 Policy No.:
'
CERTIFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE
mus seetim Actual mmaeomplemd Vasa Permit i, formahundrod chases (SIM)
mins)
1 arufv Nat in to performance of dr, work for which Shia Permit u issued, l tall an,
employ any penin in MY matter SO as m Wecume,ubjat la to Workeri ComPematim
Lama of CalifantiL Dam
Applicant
NOTICE TO APPLICANT: If, after making lhu Certificate of Exemption, you Should
became subject m to Workch Compensation provisions of dr, Labor Cods, you a=
foMwit comply with such provisions or to Permit shall W deemed ranked.
CONSIBUCf10N LENDING AGENCY
affirm dot there is a conStnotion lending agency for the perfaasuna of
-
to worst for which Nb permit is issued (Sec. 3099. Civ. C.)
lenders Name
.
I<rdsrs Address
I certify Mat I have Rad this application and sum tat to Chow information u
careLL 1 agree a comply with JI city and county on inst as and sero laws relating to
Wilding comtRtion, att W mby authorise rtprtxnutivca of to city m enter upon to
above-mentimod Property for inspection Parnassus
(We) agree a save, indemnify and keep harmless the City of Cuperum against
Iiabilim,judgments, coca and espcmca which may in any way accrue against said City
in consequence of Me gating of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
�) r1
Issued by:9 Date /V' > (L4 -
SOURCE REGULATIONS.
Re -roofs
Type of Roof
p'
SignatuiE afApplica uCanuaclur I D m
HAZARDOUS MATERIALS DISCLOSURE
Will the Applicant or future Wilding aauPavt Star, a battle bvudom material
AS defined by to Cupertino Municipal Code. Chapter 9.13. and the Halt and Safety
Cole, Scotian 25532(x)?
[:3 Yes RN/o
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
Will der: applicant or feature Wiling oaapant our equipment or, &A= which
it hrardnus air conesnu is as Jcfined by She Bay Arta Air Quality ManagcmcnL
all new materials for inspection.
suicR
Yo NO
I have mad Me bvardms materials mparamenta undcr Ch mA06.95 Alto Calilm.
nix Hcalt h Safety Cads. Sections 850.5,25533 att8534. 1understand tatiflW Wilding
does rat currently have • tenant Mu It AS my to ponsibility in amil, the ac,surt of Me
RquiRmcw wbkh muss Memel priorm itsuancc of a Dmifmate of
Signature of Applicant Date
1031 OS
3YIrind
All roof coverings to be Class'%” or better
Owner '
gent)L1./1!1
or autarimd aper am
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W
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: I 0q2 NGVembe r -Dy
PERMIT #
OWNER'S NAME: Ct {^
PHONE # L+C)Ej q & 3432-Fj
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: cLhiA64� (0 /3( 1 Lo8
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
0
•
•
CITY OF
CUPER1INO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
NOUV
APN # . 00-00
OD
Date: I Jos
Building Address:
l0 ,z Ovembc Cucr-h r)o a5o m
Mailing Address (if different from building address):
Owner'sName: ar,
Phone #�:1 6 019
Contractor: X913 `/� r1"%2
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Phone-(
S c�rC� � ►4o
Fax: (,SOS —(o
Contractor License #: 7tea IO
Cupertino Business License #:
Contact:
n
Phone:
% 22Z
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Den
Fax:
Residential Commercial
Job Description: ,
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Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B Z II/IIIN-A ❑ IUIII B, IV -HT, V -B ❑
Valuation: D- 000_ CIO Square Footage:
Project Size: Ex ress Standard ❑ Laze ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at.www.builditereen.ore
Revised 10/20/08