11010071 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11210 MOUNT CREST DR CONTRACTOR:SOLARCITY PERMIT NO: 11010071
OWNER'S NAME:
FOSTER CITY,CA 94404 PHONE NO:(650)638-1028
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License ClassC4i& Cly.6 tic.# ` f5;tyb ypzz
n MECH RESIDENTIAL� COMMERCIAL
5r
Contractor �j,(-( 1—" Date Z'>� -2 �s
Thereby'affirm that[am licensed under the provisions of Chapter 9 JOB DESCRIPTION:9.03KW ROOFMOUNT PHOTOVOLTAIC SYSTEM-43
(commencing with Section 7000)of Division 3 of the Business&Professi PANELS/UNITS 22SAMP SERVICE PANEL UPGRADE
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two decl ions:
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 Sq.Ft Floor Area: Valuation:$63000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35626027.00 Occupancy Type:
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above infonnation 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180/)DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DA OM LAST CALLED INSPECTION.
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. Issued by: r Date:
.Signature Date
RE-ROOFS:
13OWNER-BUILDERDECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Sa' Cod e,Sections 25505,25533,and 25534.
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 Owner, r a horized gent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is'a construction lending agency for the performance of work's
1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all tion-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional_
Signature Date
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11210 mount crest dr.
DATE: 01/12/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$63,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
install solar panels at existing sfd rooftop
SCOPE
1-kch. Plan Check
Phan . I ! + . hccx
Elec. 11/,w Cherk FT
;arch. PC, Vow Po'.
Ph+nah. F'c+;r=il 1';
174. . P"x-alff
Other Afec;h. lnsp.
Orl+cr ,'lun:b Insil.
011rrr Elrr. hw,). Lj
Ucch. ln.,p. Fcc.
Plumb. In l+. l-r
Eloc. hop. N-v.
NOTE: These fees are based on the Preliminary information available and are only an estimate Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 09-051 U. 7i1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$207.00
Photovoltaic System
ISOLARRES
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee{i Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conslruction .Ta.v
Acoustical Fee: 0 Yes 0 No
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
0
Tiywvel Docnnnentu7ion Fees:
Strong Motion Fee: IBSEISMICR
$6.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$9.30
$207.00
TOTAL FEE:
$216.30
Revised: 12/07/2010