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10110035CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22071 LINDY LN CONTRACTOR: SOLARCITY PERMIT NO: 10110035 OWNER'S NAME: WAGUIH ISHAK 393 VINTAGE PARK DR STE 140 DATE ISSUED: 11/05/2010 IER'S PHONE: 6502835501 FOSTER CITY, CA 94404 PHONE NO: (650) 638-1028 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB / License Class C, Lic. # r—I—� CC J O Ltd Q. C Date MECH RESIDENTIAL COMMERCIAL Contractor �T_ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL DEDICATED 240V CURCUrr, NEMA 14-50 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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 Sq. Ft Floor Area: Valuation: $1500 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. APN Number: 35627014.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Addit nally, the applicant understands and will comply the Cupertino Municipal Code, Section Date 0 with all non-pointper Issued by'r<�— Tregt#6ons 9.18. Signature Date RE -ROOFS: Li OWNER -BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 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: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self -insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(x) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. p Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Own or au o ' Compensation laws of California. If, after making this certificate of exemption, I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes. (We) agree to save mnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION ., and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO wo FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 22071 lindy lane QTY/FEE DATE: 11/05/2010 REVIEWED BY: BP FEES APN: % 0 BP#: 0 l ` *VALUATION: 1$1,500 *PERMIT TYPE: Electrical Permit 1 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex lex USE: ''1 c 100, .4AV-,,. PENTAMATION 1 REAP10 PERMIT TYPE: WORK SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Elec. Permit Fee: 1EPERMIT Recep/Switch/Outlets 1BREMRECEP Other Elec. Insp. 0.0Fhrs]$42.00 1 # $42 Perini! Fcc_- .S`arpp[ I rt p F'c PME Unit Fee: $42.00 PME Permit Fee: $42.00 r�t;U2dSltc'tFt 1�€'1'IE'�1' � C '. Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resohitiort 09-051 Eff T1/10) FEE QTY/FEE Elec. Plan Check 0.0 hrs $0.00 c: 1 lon C'hc(4 [cc: Elec. Permit Fee: 1EPERMIT P Other Elec. Insp. 0.0Fhrs]$42.00 PME Plan Check: $0.00 NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resohitiort 09-051 Eff T1/10) FEE QTY/FEE MISC ITEMS c: 1 lon C'hc(4 [cc: S1/pp/. PC,' [cc c PME Plan Check: $0.00 Perini! Fcc_- .S`arpp[ I rt p F'c PME Unit Fee: $42.00 PME Permit Fee: $42.00 r�t;U2dSltc'tFt 1�€'1'IE'�1' � C '. Work Without Permit? 0 Yes E) No $0.00 1'lcartrtiu,�.> 1�'� Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 10/17/2010 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk:'Lot: APN ........: 35627014.00 DATE ISSUED.......: 11/05/2010 RECEIPT #......... BS000011927 REFERENCE ID # ...: 10110035 SITE ADDRESS .....: 22071 LINDY LN SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: WAGUIH ISHAK ADDRESS ..........: 22071 LINDY LANE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: TraciC COPY # : 1 RECEIVED FROM ....: SOLARCITY CONTRACTOR .......: LYNDON RIVE LIC # 28844 COMPANY ..........: SOLARCITY ADDRESS ..........: 393 VINTAGE PARK DR STE 140 CITY/STATE/ZIP ...: FOSTER CITY, CA 94404 TELEPHONE ........: (650) 638-1028 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 1,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BREMRECEP NO. OUTLETS 1.00 42.00 0.00 42.00 0.00 1BSEISMICR VALUATION 1,500.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 TOTAL PERMIT ---------- 127.50 ---------- 0.00 ---------- 127.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 127.50 --------------- 127.50 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL 512 FINAL HANDI-CAP REFERENCE NUMBER -------------------- 210882 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Z, Zp - PERMIT # OWNER'S NAME:r, PHONE # 97-5 -- S GENERAL CONTRACTOR: e BUSINESS LICENSE ADDRESS: - ,� CITY/ZIPCODE: e - *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CO TRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I /. rho I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date 1. Use Low/No-VOC Paint 1 lAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y --yes 7. Seas all EVosed Pat#icleboard or MDF 4 IAQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available:1 1401 1301 57 Total Points Project Received: 01 0 0 � ll't - /-(, G:data/progslgreenbuildmgguidelineslremodelerslgreenpointsfina1212.D4protected.xls CM OF CUPS T1NO tTIo CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # � r. � ,-� � ,, /' Date: � Building Address: � J 2 Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA:(Exterior work only)Yes No ellif yes, provWe letter from HOA Owner's Name: _-Ir— Phone # Contractor: Phone: Fax: Contractor License Cupertino Business License #: Contact: � h : Phone141V Fax: j .cesidential Commercial Job Description: -?�-57- I LL �� (C TS CIA t V ( T /V��MA /Y-7�0 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U/EW-A ❑ II/III B, IV -HT, V -B ❑ _ Valuation: Square Footage: t Project Size: Express �andard ❑ Large ❑ 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. Ants Achieved: -r-or help, contact Build it Green at Revised 07/14/09