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14100187-PUBLICCITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10460 IMPERIAL AVE I CONTRACTOR: SOLARCITY PERMIT NO: 14100187 OWNER'S NAME: Ld LICENSEDCONTRACTOR'S DECLARATION License Class (0 i . #Q I O Contractor Date /65 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this 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 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. Additional , the applicant understands and will comply with all non -point source regulati s the Cupertino Municipal Code, Section 9.18. Signature Date (-'-f ZU L5 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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). 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. 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. 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 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. SAN MATEO, CA 94402 I PHONE NO: (650) 638-1028 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALL 15 ROOF TOP, FLUSH MOUNTED PV PANELS, 3.9 KW REVISION #1: REVISE TO INSTALL (17) MODULES AND INSTALL NEW 125 AMP SUB -PANEL. ISSUED 4/22/15 Sq. Ft Floor Area: I Valuation: $8000 APN Number: 35719088.00 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: �'' N���(�f7 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 I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 Ai uality Management District I will maintain compliance with the Cupertino M nic' I Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 2 3, 25534. �1 Owner or authorized agent: 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 I understand my plans shall be used as public records. Licensed Professional Signature Date CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 l \i (408) 777-3228 • FAX (408) 777-3333 • buildinq(@cupertino.org \ PROJECT ADDRESS 10460 IMPERIAL AVE. APN#(� , ��� OWNER NAME TW I SAM PA f i M l f RA PHONE 408-218-0748 E-MAIL STREET ADDRESS 10460 IMPERIAL AVE. CITY, STATE, ZIP CUPERTINO,CA 95014 FAX CONTACT NAME Marjan Javanmard 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 N CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Sola rCity Corporation LICENSE NUMBER 888104 LICENSE TYPE C 10 1 BUS. LIC # 288 i1 0 (JV`� COMPANY NAME SolarCity Corporation E-MAIL n-Ijavanmard@solarcity.com FAX STREET ADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477.6430 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ NO ❑ SOLAR PANELS TEI ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 15 5 KILOWATTS (COMMERCIAL ONLY): f Q J l TOTAL VALUATION: CJ �) QQ ) o DESCRIPTION OF WORK Installation (15) rooftop flush mounted solar panel (3.9) kW CEI By my signature below, I certify to each of the following:4e,hp erty owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is correct. rhe Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construc 'o e esentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: I n // SUPPLEM TAL INFORMATION REQUIRED OFFICE USE ONLY W a x ❑ OVER-THE-COUN-FVR ❑ EXPRESS U ❑ STANDARD U ❑ LARGE a ❑ MAJOR PFApp_2011.doe revised 03116111 CUPERTINO / I -- �901Z�7 ALTERNA� �Y�E IT APPLICATION COMMUNITY DEV L P NT DEPART ING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building ancupertino.orq PROTECT ADDRESS j u Pam{ I _ !l l L� ��I ` 1 �l/ ll 7APN # OWNER NAME 1. Tt� I so, N, n I ; r�� PHONE © _ Q E-MAIL STREET ADDRESS ��' / �` . j I V V' � © FAX CITY, STATE, Zj,P ' 11,50 CONTACT NAME L PHONE Y r �.Vc Y ryrr E-MAIL STREET ADDRESS .�CI t1/ .1 1 r I CITY, STATE� •+ e A 9 `> FA" `.. .. ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT❑ CONTRACTOR R CONTRACTOORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �1� �a{ 1 1 Y 1� LICENSE NUMBER ,. / o-';7 l1 LICENSE TYPE C..,L BUS. LIC # 5 �' COMPANY NAME E-MAIL FAX STREET ADDRESS 3CL FO S �� -1 IJ CITY, STATE, ZIP �c-A I w-fd PHONE r,+ t _�.. - � q ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ❑ Multi -Family STR CTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE Yes ❑ No SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING �I_ ❑ OTHER: _ /✓ FOR SOJ.AR PANELS: NUMBER OF PANELS/UNITS j KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION; Cif/'(1FN k> ' t 1� .' \-C,-_0\Ck 7 Ck VAEVS [ • j �`� V v�_ J�N i tDnpj RECEIVED BY , By my signature below, I certify to each of the following: I am the progIe er or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have /reat e,cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I autht sentatives of Cupertino to enter the above -identified property) for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN A FORMATION REQUIRED_, OFFICE USE ONLY= E U ?4 OVER THE COUNfER �i {� EXPRESS g PVApp_2011.doc revised 03116111 CITY OF CUPERTINO EM-7.0, FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10460 IMPERIAL AVE DATE: 10/30/2014 REVIEWED BY: MELISSA APN: 35719 088 BP#: i�l d�l� 'VALUATION: 1$8,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK INSTALL 15 ROOF TOP FLUSH MOUNTED PV PANELS 3.9 kW SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution II-053 Fe 'V]3 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $236.00 Alternative Energy System IPHOTOVREs Photovoltaic System Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT p,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bld-g Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.04 $236.00 TOTAL FEE: $238.04 Revised: 08/20/2014 CITY OF CUPERTINO RM-7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10460 IMPERIAL AVE DATE: 04/22/2015 REVIEWED BY: SEAN APN: BP#: 'VALUATION: 1$1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 REAP2 PERMIT TYPE: WORK REVISION #1: REVISE NUMBER OF MODULES TO 17 MODULES AND INSTALL A NEW SCOPE SUB -PANEL (125 AMPS). !'r';.r=; Elec. Plan Check 0.0 hrs $0.00 t t>>J Ir t>t /'0!,! t cv- Ph,fl,h O's . "?cif Elec. Permit Fee: IEPERMIT j//,°,:> r s ,:. �,>•>r> �rf3 >;);?;rr,r„,r; ; r<<,>E]__1_ Other Elea Insp. 0.0 hrs $48.00 11t� , ;ii.fl �� i f, n(fliJi!), fJl tr 1. f'i'. l�. tf•J �d'+��? � �.�. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff.7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 125 amps Electrical $48.00 IBELEC200 Services Suppl. PC Fee: Q Reg. OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-(F) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 0 Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: ITRAVDOC $48.00 Strom,, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $142.50 $48.00 TOTAL FEE: $190.50 Revised: 04/01 /2015