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15070156CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10123 AMADOR OAK CT CONTRACTOR: SOLARCITY PERMIT NO: 15070156 OWNER'S NAME: SINGHAL AMAR AND GOEL RICHA 3055 CLEARVIEW WAY DATE ISSUED: 07/22/2015 O ER'S PHONE: 8584051817 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 Ed LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL t�� l INSTALL 11 ROOF TOP PV MODULES (2.86 KW) C 5 CLW � License ClassLicCl� 'i � � Q �Y 1# Contractor 0 1 Date�� I hereby affirm that I am licensed un er 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: 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: $6000 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: 34232023.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PFR1ViTT ISSUANCE OR YT—E upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY -M. LAST CAJAD INSPECTION. 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. Addition Ily, the applicant understands and will comply Isrued by: ate: with all non -point source reg ul ons p he Cupertino Municipal Code, Section 9.18. / Signature Date (_5 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. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air lity Management District I performance of the work for which this permit is issued. will maintain compliance with the el ' ipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, See* s 25505553 d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 41:7 Date:j �5 permit is issued. 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date C PERTINO ALTERNATIVE ENERGY PERMIT IIT APPLICATION i`rO:4wtUPJ:T )e . ___t.�.,rl�1�d'�' �i_rt;�.�c Il��it.I� t � rz�t,�.Gl� � i�l�?�ifi, �,� AE '40 ) 77 26 - FFAX PROJECT ADDRESS �I c 6 fi f � � n, C � cq y- &c d , �4 APN 0 OWNER NAME i y �a(yb�ti ✓1 C \C� ` P—J I C) E-MAIL STREET ADDRESS ArgClf�C� LJGiK C � a PEr l `� �� 1�� I �� FAX CONTACT NAME Marjan Javanmard PHO"'E650.477.6430 E-MAIL mjavanmard@solarcity.com STREETADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 19 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMESolarCity Corporation LICENSENUNBER888104 LICENSE TYPE C10 BUS. LIC g28840 COMPANY NAME SolarCity Corporation E-IlLmjavanmard@solarcitylsscom F^" STREETADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PH0'`E650.477.6430 ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRU TORE: ❑ Commercial PROJECT N WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT N FLOOD ZONE ❑ Yes ❑ No aSOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: , 0 KILOWATTS (COMMERCIAL ONLY): p (s� TOTAL VALUATIONS / DESCRIPTION OF WORK Installation rooftop flush mounted solar panel V-•'2 tg) kW ErVED BY: -f _ By my signature below, I certify to each of the following: I am thnropeRy' o er or authorized agent to act on the_prop owner s behalf. I have read this application and the information I have provided is correct. I have.read the,D cription of Work and verify it isadcurate. I agree to comply with all applicable local ordinances and state laws relating to building cc stnxcti'om - i orae presentatives of Cupertino to enter the above -identified propertygfor inspection purposes. Signature of Appl icant/Agent: ._ Date: SUPPL�� AL INFORMATION REQUIRED OFFICE, USE ONLY ❑ OVER-THr COUNTER Fv F ❑ I;xppx, ss U v ❑ STANDARD U a❑ LARGE � I ❑ Iv1AJOR PVApp_2011.doe revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 10123 AMADOR OAK CT DATE: 07/22/2015 REVIEWED BY: MELISSA -loch. 1'errnil Fee: APN: 342 32 023 BP#: *VALUATION: 1$6,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 11lurnb. Insp. Fee: PENTAMATION SOLAR -RES PERMIT TYPE: WORK INSTALL 11 ROOF TOP PV MODULES 2.86 k SCOPE Suppl. Insp. Feer Reg. 0 OT0 !VOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminarv, information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) Xh,ch. Plan Check Plttntb. Plum Check 1'lec. Plan Check -loch. 1'errnil Fee: Plumb. Permit Fee: lilec. Permit Fee: Other ;tlech. Insp. Other Plumb Insp. Other Elec. Insp. ;tlech. Insp. Fe'. 11lurnb. Insp. Fee: Elec. Insp. Fee: !VOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminarv, information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System $236.00 1PHOTOVRES I Photovoltaic System Suppl. PC Fee: (j) Reg. Cl OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :I ax: T -r Atbninistrat4 (. 1 'ec, . E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel%7C7C'7XlnF''i7l(XZlf.'In Fees:� Strong Motion Fee: 1BSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS." $1.78 $236.00 TOTAL FEE $237.78 Revised: 07/02/2015