15070192A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22289 JANICE AVE
CONTRACTOR: SOLARCITY
PERMIT NO: 15070192
OWNER'S NAME: CHENG CHIN K AND SHWU Y L
3055 CLEARVIEW WAY
DATE ISSUED: 07/29/2015
OWNER'S PHONE: 4087770258
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
�p
License Classy Cep Lic. # p 10(5.46
INSTALL 21 ROOF TOP, FLUSH MOUNTED PV MODULES
KW)
Contractor lay Ci {"� Date J � 5
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.
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.
I have and will maintain Worker's Compensation Insurance, as for by
Sq. Ft Floor Area:
Valuation: $12000
provided
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35701106.00
Occupancy Type:
permit is issued.
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 WO RI STARTED
to building construction, and hereby authorize representatives of this city to enter
WITIIIN 180 DA + SSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino liabilities,
180 DAY LED INSPECTION.
against judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additio ly, the applicant understands and will comply A
`by- e: /
with all non-point source regul ionsWr the Cupertino Municipal Code, Section
9.18,
Signature Date 0RE-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
❑ OWNER-BUILDER DECLARATION
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I have and will maintain a Certificate of Consent to self-insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or devices which emit hazardous
performance of the work for which this permit is issued.
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Nfunicival Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 233, d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Dater
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
forthwith comply with such or this be deemed
I hereby affirm that there is a construction lending agency for the performance of
work's for this is issued
provisions permit shall revoked.
which permit (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, 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
Licensed Professional
9.18.
Signature Date -
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOKAE.NT DEPARTMENT • BUILDING DIVISION
i0300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(4v8) 777-3223 • FAX ;409) 777-3333 • buildinarCUDertino.ora
��_o
PROJECT ADDRESS n o APN # / /
di f% � C7
OWNER NAME PHONE
�=Y,lV` Taj - -
�� /
("k -
E-MAIL
STREET ADDRESS !j CITY, STATE, ZIP FAX
yC ( .lr'At L� i Jt >�� f
C_-40 e -V, I rt 6 (' c' ,
CONTACT NAME
Mar an Javanmard
Marjan 'PHONE 650.477.6430 E-MAILmjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑o CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME SolarCity Corporation
LICENSE NUMBER 888104
LICENSE TYPE C10
BUS.LIC{t28840
COMPANY NAMESOIarCity Corporation
E-MAILmjavanmard@solarcity..com
FAX
STREET ADDRESS 391 Foster City Blvd -
CITY, STATE, ZIP Foster City, CA 94404
PHG'IE650.477.6430
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS /
CITY, STATE, ZIP
PHONE
USE OF a SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ No
❑ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: d I KILOWATTS (COMMERCIAL ONLY): C I
N-- v
TOTAyjL V U/ATIOlJ
t 5J f)�- 1 J 0 l'M1
DESCRIPTION OF WORK
Installation_,( ) rooftop flush mounted solar panel ��`-ze�) kW
D
By my signature below, I certify to each of the following: I am the/prop owner or authorized agent t act on the property owner' alf. I have read this
application and the information I have provided is correct. I have lead,thDescription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I aut oljze representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: i ,� Date: o f % Zl
SUPPLEMENTAL�ORMATIO-N REQI U.RED
rte•
OFFICE USE ONLY
❑ OVER -TAE -COUNTER
❑ EXPRESS
❑ STANDARD
U
U
a
❑ LARGE
a
❑ MAJOR
PVApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
—1— 1/{La escimuae uoes not inctuaeJees aue to other Departments (ie. Planning, Public Works, Fire, Sanitmy Sewer District, School
District, etc.). These fees are based on the nreliminary information availahia a"d Ora nsdv a„ -f;-0. n„:. f .11— n.,,s ,r-- _44-51
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
SS: 22289 JANICE AVE
ADDR�3�5701
DATE: 07/27/2015
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 106
BP#: 112
*VALUATION: 1$12,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION
PERMIT TYPE: SOLAR -RES
WORK [N�S�LL21
ROOF TOP FLUSH MOUNTED PV MODULES 5.46 kW
SCOPE
Suppl. Insp. Fee.Q Reg. 0 OT
—1— 1/{La escimuae uoes not inctuaeJees aue to other Departments (ie. Planning, Public Works, Fire, Sanitmy Sewer District, School
District, etc.). These fees are based on the nreliminary information availahia a"d Ora nsdv a„ -f;-0. n„:. f .11— n.,,s ,r-- _44-51
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
# Alternative Energy System
$236.00 IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (D Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.Q Reg. 0 OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? 0 Yes D No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure 0
,
Strong Motion Fee: IBSE1SAffCR
$1.56
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS
$2.56
$236.00 °f` T0TALFEE ;
$238.56
Revised: 07/02/2015