15060068-pub20199 PACIFICA DR
15060068
F/P
BHUPINDER KHATTRI
SCANNED BOX #598
.AJ
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20199 PACIFICA DR
CONTRACTOR: SOLARCITY
PERMIT NO: 15060068
OWNER'S NAME: BHUPINDER KHATTRI
3055 CLEARVIEW WAY
DATE ISSUED: 06/09/2015
OW ER'S PHONE: 6502246646
SAN MATED, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
INSTALL 36 ROOF TOP, FLUSH MOUNTED PV MODULES
License Class �'- 10 C,'a-('9 Lic. #
(9.36 KW) & INSTALL (N) 125 AMP SUB PANEL IN SIDE
Q }-�
�c� ��, / Z I
YARD (AROUND THE CORNER FROM (E) MAIN)
Contractor >c� � i Date (, `j
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:
l 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: $19000
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
APN Number: 3692901 I.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 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 LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may ccrue against said City in consequence of the
granting of this permit. Addt nallyr a applicant understands and will comply
with all non -point source re latiofis er the Cupertino Municipal Code, Section
9.18. �.
�,1
'r` "'---
RE -ROOFS:
Signature �Date .S
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
Signature of Applicant: Date:
[ 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
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)
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 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 Are"ir Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertir'Mu flcipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505 553�i; and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: i Date:ZL
L
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, 1 must
1 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
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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1408) 77' FAX -4,38) 777-3333 • building ftuper ino.org n W
PROJECT ADDRESS ., _ e q q `t c[ I' n C C r r
APN #
/f
'
OWNER NAME F� Y, C e_ y1(,�`I _ jR y,
�l- T� Y b\
PHONE _ E-MAIL
(/C' G
STREET ADDRESS
�)I ` ac.t t
ITY, STATE, ZIP FA4X
c� - 3�f
CONTACT NAME Marian Javanmard
PHONE650.477.6430
E-NIAILmjavanmard@solarcity.com
—]—
STREET ADDRESS391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 9 CONTRACTOR AGENT ❑ .ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMESoIarCity Corporation LICENSE NUMBER888104 LICENSE TYPE C10 BUS LTC#28840
COMPANY NAMESoIarCity Corporation E-MAILmjavanmard@solarcity.com FAX 00
STREETADDRESS391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PH°NE650.477.6430
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS LTC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
STR CTURE ❑ Commercial
PROJECT IN WILDLAND
URB.SN 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 36 KILOWATTS (COMMERCIAL ONLY): q 2
[ �b
TOTAL VALUATION ' Cj
DESCRIPTION OF WORK
Installation", rooftop flush mounted solar panel (.36) kW
By my signature below, I certify to each of the following: I am the Top own ttzed agent to a e pro o alf. ve read this
application and the information I have provided is correct. I have read th escr on of Work and verify it is accurate o com th all applicable local
ordinances and state laws relating to building construction. I aut pre Ives of Cupertino to enter the above-i perty for inspection purposes.
Signature of Appl icant/Agent: �� Date: Cv 5
SUPPLEMENTAL ATION RNIMLED
OFFICE USE ONLY
W
❑ OVER -TIDE -COUNTER
❑ EXPRESS
5�
❑ STANDARD
U
i❑
LARGE
a
❑ MAJOR
PVApp 201 Ldoe revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
AADDRESS:
20199 PACIFICA DR
DATE: 06/09/2015
REVIEWED BY: MELISSA
l APN: 369 29 011
BP#:
*VALUATION: 1$19,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
INSTALL 36 ROOF TOP FLUSH MOUNTED PV MODULES 9.36 k & INSTALL N 125 AMP SUB
SCOPE
PANEL IN SIDE YARD (CORNER FROM MAIN)
Elec. Plan Check 0.0 hrs $0.00
": _
..
Elec. Permit Fee: I EPERMIT
Other Elec. Insp. 0.0 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'l info.
FEE ITEMS (Fee Resolulion II-053 Eff 7iU13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: O Reg. Q OT
O, 07
hrs
$0.00
PME Plan Check:
$0.00
125 1 amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
0
0
Work Without Permit? o Yes (F) No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non -Residential
Building or Structure
(F)
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$2.47
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS
$144.47
$284.00
TOTAL FEE:
$428.47
Revised: 05/07/2015