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10080177 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21550 ADDINGTON CT CONTRACTOR:SOLARCITY PERMIT NO: 10080177 OWNER'S NAME: RAVI GOPAL 393 VI NTAGE PARK DR STE 140 DATE ISSUED:08/24/2010 BIER'S PHONE: 5105793209 FOSTER CITY,CA 94404 PHONE NO:(650)638-1028 LICENSED CONTRACTOR'S DECLARATION L� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C 4 6 ,C,0, Lic.# stir 1641 (— I- Q - MECH RESIDENTIAL COMMERCIAL Contractor _ Date 8-,7A —91i,Io hereby affirm th/tI(ni censed under the provisions of Chapter 9 JOB DESCRIPTION:200AMP SERVICE PANEL UPGRADE (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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000 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:35622032.00 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 P ERMIT 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, 1;30 DAYS FROM LAST CALLED INSPECTION. 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 regulat' s per the Cupertino Municipal Code,Section IssuesI by: - Date:d' p 9.18. Signature ` Date RE-ROOFS: L.. OWNER-BUILDER DECLARATION All ro<Is shall be inspected prior to any roofing material being installed.If a roof is installs xl 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 inspec ion. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signat are 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. I 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(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Addit onally,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. maint iin compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Co ,Sections 25505,25533,and 25534. 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 Owner thor' age Compensation laws of California. If,after making this certificate of exemption,I Date: 4d5'ELI_ 0-0;6 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 wt ich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lend(is 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 Lend4 is Address upon the above mentioned property for inspection purposes.(We)agree to save i inify and keep harmless the City of Cupertino against liabilities,judgments, 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 I undo rstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licen red Professional Signature Date CITY OF CUP:ERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35622032 . 00 DATE ISSUED. . . . . . . : 08/24/ 2010 RECEIPT #. . . . . . . . . : BS0000L1274 REFERENCE ID # . . . : 10080177 SITE ADDRESS . . . . . : 21550 ADDINGTON CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . RAVI GDPAL ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4847 RECEIVED FROM . . . . : SOLARCITY CORPORATI CONTRACTOR . . . . . . . : LYNDON RIVE LIC # 28844 COMPANY . . . . . . . . . . : SOLARCITY ADDRESS . . . . . . . . . . : 393 VI.gTAGE PARK DR STE 140 CITY/STATE/ZIP . . . : FOSTER CITY, CA 94404 TELEPHONE . . . . . . . . : (650) 538-1028 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 000 . 00 1 .00 0 .00 1. 00 0. 00 1EPERMITFE FLAT RATE 1. 00 12 .00 0 .00 42 . 00 0 . 00 1ERT<200 UNITS 1. 00 12 . 00 0 .00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 12 . 00 0.00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.00 0. 00 127.00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127 .00 #110977 --------------- TOTAL RECEIPT 127 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUF'ERTINO FEE ESTIMATOR- BU[LDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: I BP#: "VALUATION: j$2,000 *PERMIT TYPE: Electrical Permit I PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY f t�,'' I_ PENTAMATION 1 REAP14 USE: SFD or Duplex I j."?t)r}?, ;f'?:.�. PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Temporary Power 1 ERT<200 1 $42 TOTALS: I I I I $42.001 . I I Elec.Plan Check 10.0 I hrs $0.00 I• ,. i I Elec.Permit Fee: 1EPERMIT LJ I Other Elec.Insp. LE hrs I $42.00 NOTE: These fees are based on the preliminary information availal,le and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7/1"'10) FEE QTY/FEE I MISC ITEMS /,/,/)r t 1"c "A 1 i'': slipp!. P l cc PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Tax P uifS,`tc',Lt iia'17t'tti' /<',': Work Without Permit? © Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 •g?,.,,, ,, f , t; 1.,. • Select an Administrative Item Bldfz Stds Commission Fee: IBCBSC $1.00 I SUBTOTALS: I $127.00 $0.00 TOTAL FEE: I $127.00 Revised: 8/17/2010 } -Aa- CITY OF CUPERTINO CU CITY OF]NO GENERAL BUILDING PERMIT APPLIC,kTION FORM APN # '�3��-� �. `-. � � I Date: Building Address: I AAA,,,, ��y Mailing Address (if different aim building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: R C,V. (.r e a l ,o --,:In Contractor: Phone: £sue 6,36 k az 8 t�,., Fax: .6sD Contractor License#: ' Es,�56 1v Cupertino Business License#: 2 Contact: ' Phone: E;s a ZZZ '324,u- Fax: 'C5� 63e it�z Residential Commercial ❑ Job Description: .2 0 0 A Building Permit Info: ' Bldg 21 Elect E` Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A n II/III B, IV-HT, V-B 0 Valuation: Square Footage: Project Size: Express Standard Large ❑ Major ❑ 0--t- r 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. 'oints Achieved: For help, contact Build it Green at www.builditgreen.org Revised 07/14/09 i IADHealth M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAC/Health pts y—yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts y--yes 0 3.Use Low/No VOC Adhesives 3 IAC/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Re:;ource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AC/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts y=yes 0 7.Seal all dosed Partioleboard or MDF 4[AC/Health. pts y=yes 0 S.Use FSC Certified Materials for Interior Finish 4 Re:;ource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y—yes 0 10.Install Whole House Vacuum System 3 IAO/Health pts y--yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0 ! 1 1 Total Points Available: 1 1401 1301 571 Total Points Project Received: �5A 01 01 01 G:data/progs/greenbuildn tguidelines/re modelers/greenpointsfinal2.12.D4protected.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 21 SSG AcAA Vin PERMIT# 10 i -7--7 OWNER'S NAME: ���„; &� � `J PHONE# 5/b S`-.7 -7 c7- GENERAL CONTRACTOR: �M�- CV11 BUSINESS LICENSE# Zt6tiZi l� ADDRESS: ��j ��� � P��k�r �'lz(o CITY/ZIPCODE: t—U$Ye'-( *Our municipal code requires ah businesses working in the t ity 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 SUBCONTRAC TAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Si atu re Date Please check applicable subcontractors a plete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/Glazing l Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date