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15020157 PUB21075 GARDENA DR 15020157 VOIDED JOB CANCELLED MUMMANENI VIJAYABABU AND MADHURI SCANNED BOX #598 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21075 GARDENA DR CONTRACTOR: SOLARCITY PERMIT NO: 15020157 OWNER'S NAME: MUMMANENI VIJAYABABU AND MADHURI 3055 CLEARVIEW WAY DATE ISSUED: 02/27/2015 OWN R'S PHONE: 4089638539 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL (8) PANEL PV SYSTEM ON SFDWL 2.08 KW, ADD License Class C (,o L.. # ��4 G' b 125 AMP SUB PANEL Contractor I hereby affirm.tha am licensed under the visions of Chapter 9 (commencing w� 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: $4500 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 APN Number: 32608077.21075 Occupancy Type: permit is issued. 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F AST CALLED 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 Date: 47 granting of this permit. Addition . , th plicant understands and will comply Issued by: with all non -point source re p e Cupertino Municipal Code, Section 9.18. Z1.5 RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is t installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 1, 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. I 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 equipme t 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 Are it Qua#ty Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti Mum al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 533, d 25534, Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date I 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, 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 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1 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 CVPERTINQ ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^ ,, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 14 (408) 777-3228 • FAX (408) 777-3333 • building an-cupertino.org PROJECT ADDRESS (J -�0 J ^ I,,YC�e r , APN # �� OWNERNAME V 1(��I �A �Lk, -NN,��N,1 �n 1 PHONE 63 _ �53 E-MAIL STREET ADDRESS 9'® 0-\, (\� CITY, STATE, ZIP C� ©tC� FAX CONTACT NAME Marjan Javanmard PHONE650.477.6430 E-MAILmjavanmard@solarcity.com STREET ADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR IN CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESoIarCity Corporation LICENSE NUMBER888104 LICENSE TYPE C10 BUS. LIC#28840 COMPANY NAMESoIarCity Corporation E-MAIL mjavanmard@solarcity.com FAX STREET ADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477.6430 ARCHITECT/ENGWEER 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 El SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: y,Soo•oo FOR.SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK .aX Installation (g ) rooftop flush mounted solar panel () kW Li A rq . 0 clv�z RECEIVED BY: the p erty ner or authorized agent to act on the property ow s beh have read this By my signature below, I certify to each of the following: L[havc application and the information I have provided is correct. re ,the 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.tho dre sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: D.�� or / fl 5 SUPPLEMENTA I ORMATION REQUIRE ._ OFFICE USE ONLY W ❑ OVER-THE-COUNTER yay F" ❑ EXPRESS CSC U w x ❑ STANDARD U z ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21075 gardena dr DATE: 02/27/2015 REVIEWED BY: Mendez APN: BP#: /5 'VALUATION: 1$4,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: WORK install 8panel pv system on sfdwl 2.8 kw add 125 amp sub panel SCOPE t Elec. Plan Check 0.0 1 hrs $0.00 tie Elec. Permit Fee: IEPERMIT EDOther Elea Insp. Fo.0 hrs $48.00 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'1 info. FEE ITEMS (Fee Resolution 11-053 E.' 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: (F) Reg. ® OT F070 I hrs $0.00 PME Plan Check: $0.00 1-257 amps $48.00 Electrical IBELEC200 Services Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT Fo.oThrs $0.00 PME Unit Fee: $0.00 Permit Fee: $48.00 /PME F7 Administrative Fee: IADMIN $45.00 0 (D Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: ITRAVDOC $48.00 Strong, Motion Fee: IBSEISMICR $0.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $142.59 $284.00 TOTAL FEE: $426.59 Revised: 02/14/2015