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10080059 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21640 RAINBOW CT COVTRACTOR:SOLARCITY PERMIT NO: 10080059 OWNER'S NAME: FO ITER CITY,CA 94404 PHONE NO:(650)638-1028 L LICENSED CONTRACTOR'S DECLARATION gL ILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class r CC__ MECH RESIDENTIAL COMMERCIAL r Contractor -.✓6 ' Date 7_0j,7 1 hereby affirm that 1 am lic need under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 6.04 KW ROOF MOUNTED PHOTOVOLTIAC (commencing with Section 7000)of Division 3 of the Business&Professions SY'�TEM Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 Sq Ft Floor Area: Valuation:$30000 permit is issued. APPLICANT CERTIFICATION AF N Number:36638008.00 Occupancy Type: 1 certify that 1 have read this application and state that the above information is correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED 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 granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source gulations per the Cupertino Municipal Code,Section 9.18. I?—v Iss `�ued Signature. Date t 7 -Zozo ' OWNER-BUILDER DECLARATION RE-ROOFS: 1 nereby affirm that I am exempt from the Contractor's License Law for one of Al I roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: in.talled without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, impection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Si Business&Professions Code) ;nature of Applicant: Date: _ 1,as owner of the property,am exclusively contracting with licensed contractors to — construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous(materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. C rlifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by c(mpliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Aiditionally,should I use equipment or devices which emit hazardous air permit is issued. crntaminants as defined by the Bay Area Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner uth fze agent: forthwith comply with such provisions or this permit shall be deemed revoked. — Date: 'C APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and state that the above information is I iereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating ft r which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point source regulations per the Cupertino Municipal Code.Section S. I understand my plans shall be used as public records. Signature Date I icensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21640 RAINBOW CT CONTRACTOR: SOLARCITY PERMIT NO: 10080059 OWNER'S NAME: FOSTER CITY, CA 94404 PHONE NO: (650) 638-1028 ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECTPLUMB License Class C_i p , C to }4y' Lic. # �jYj�j \C�Lj Contractor �C,��-Cat`', Date 7_0 I 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 that 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 the work for which this permit is issued. APPLICANT CERTIFICATION l certify that l 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 egulations per the Cupertino Municipal Code, Section 9.18. Signature Date 0 -(% —2 ufQ ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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. 1 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. l certify that in the performance of the work for which this permit is issued, 1 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, 1 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 1 certify that 1 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. MECH r RESIDENTIAL F COMMERCIAL' JOB DESCRIPTION: INSTALL 6.04 KW ROOF MOUNTED PHOTOVOLTIAC SYSTEM Sq. Ft Floor Area: I Valuation: $30000 APN Number: 36638008.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued br. ', �' Datej�1 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 equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner nth . gent: Date:�/Z!O/ p CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21640 RAINBOW CT CONTRACTOR: SOLARCITY PERMIT NO: 10080059 OWNER'S NAME: 94404 PHONE NO: (650) 638-1028 ER LICENSED CONTRACTOR'S DECLARATION r F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Cti6 , ab C /D. Lic. # jC)d Contractor Date t / i�) 1 hereby affir tl at am licensed under the provisions of Chapter 9 (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: 1 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. 1 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 whi this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building constriction, 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. / 1, Signature Date ❑ OWNER -BUILDER DECLARATION 1 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) I, 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. l 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. MECH r RESIDENTIAL F COMMERCIAL JOB DESCRIPTION: INSTALL 6.04 KW ROOF MOUNTED PHOTOVOLTIAC SYSTEM 12-21-10 REVISION #I - REVISE # OF MODULES, Sq. Ft Floor Area: I Valuation: $30000 APN Number: 36638008.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. 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 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owneraut r ized a I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed CITY OF CUPERTINO FM-7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21640 rainbow ct. DATE: 12/21/2010 REVIEWED BY: APN: BP#: *VALUATION: 1$36,000 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: TOTAL FLOOR AREA. PENTAMATION PERMIT TYPE - WORK revise solar panel modules inverters stem size. - SCOPE f'c .. i'Icrn Check r"lan (,hack Mcc:h. Permil Fee., Plumb, Permit Fee. "le(. Alech. Insp. Other Plumb Invp.El--L- Chher E te(. Insj; Fee: Plumh. Insp. Fee: €lec, Insp. NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Deot for addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff. 711110) FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 1 hours $126.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT FO.OThrs $0.00 PNIE Unit Fee: $0.00 PME Permit Fee: $0.00 "onsiruction Tax Acoustical Fee: 0 Yes E) No $0.00 Q Work Without Permit? © Yes (F) No $0.00 Plannin Fee: $0.00 0 Trmel Documentation Fees: Strong Motion Fee: IBSEISMICR $3.60 0 # $0.00 Revision IREVSFDWL SFDWL Bldg; Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5.60 $126.00 TOTAL FEE: $131,60 Revised: 12/07/2010