15050038-PUB10353 MIRA VISTA RD
15050038
MASSOUD VAMEGHI
SCANNED BOX #585
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10353 MIRA VISTA RD
CONTRACTOR: SOLARCITY
PERMIT NO: 15050038
OWNER'S NAME: MASSOUD VAMEGHI
3055 CLEARVIEW WAY
DATE ISSUED: 0907/2015
OWNER'S PHONE: 4089738832
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
—
INSTALL 16 ROOF TOP, FLUSH MOUNTED PV MODULES
p
License Class L I OP C2 I0 9 0 y
(4.16 KW)
1Lic.
Contractor IR�Cyl r c i L� Date f S
➢ 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:
1 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: $9500
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: 35702041.00
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 D IT 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 OM ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which accrue against said City in consequence of the
_._
�it,�
granting of this permit. Adnalj, the applicant understands and will comp y
ate: /
with all non -point source retib � per the Cupertino Municipal Code, Section
9.18.
`-A
RE -ROOFS:
Signature - Date :S 10 c
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
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
➢ 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 1 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 Ai Quality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino nici I Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25 3, a 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
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
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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPUCATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300-TORRE AVENUE • CUPERTINO, CA 950143255 /
(408) 777-3228 • FAX (408) 777-3333 e building0cupertino.ora `
I1=
PROJECT ADDRESS t �1 Al I c V' S +� I
APN #
OWNERNAMEu 11 1 /0. (
PHONE _ —�
�(2
E-MAIL
STREET ADDRESS 10 2 5 '2) 1 V ii- ok, \ I 1 Sim
1
CISTATE, ir t 1 �Q G, I
FAX
CONTACT NAMENIarjan Javanmard
PHONE650.477.6430 E-MA`Lmjavanmard@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 ❑ ENGLYEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMESOIarClty Corporation
LICENSE NUMBER888104
LICENSE TYPEC10
BUS- LICI28840
COMPANY NAMESOIarCity Corporation
E-MAIL mjavanmard@solarcity.com
FAX
STREETADDRESS391 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
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): 1
TOTAL VALUATION: %, fit0 O D
V
DESCRIPTION OF WORK
Installation (J) rooftop flush mounted solar panel kW
By my signature below, I certify to each of the following: I am the prop r or authorized agent to act n the property owner's a read this
application and the information I have provided is correct. I have read t sc�ption of Work and verify it is ccurate —I awe omply with all applicable local
ordinances and state laws relating to building construction. I authorize p se tatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: V U ! S
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
❑ EXPRESS
c7
U
❑ STANDARD
U
U
It
❑ LARGE
a
❑ MAJOR
PVApp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
MaADDRESS: 10353 MIRA VISTA DR DATE: 06/07/2015 REVIEWED BY: MELISSA
N: 357 02 041 BP#: SOSO0,3 `VALUATION: 1$9,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: I PERMIT TYPE:
WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.16 k
SCOPE
.lfeelr. Plan Check
F—V11,11, Pernril Fee:
Other 1lech. InspE17--
a-leclr. Insp. Fee:
Plumb. Plan Cheek
Plumb. Permit Fee:
Otirer Plumb Insp.Lj
Plrmrh. Insp. Fec:
Llec:..Plan Check
1;11c. Permit Fee:
Other lilec. fn p. E1__L_
Wee. Insp. Fee:
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 hosed on the nreliminary information available and are anly an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 UL 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.00
Alternative Energy System
IPKOTOVRES Photovoltaic System
Suppl. PC Fee: O Reg. O OT 0.0 hrs
PME Plan Check:
$0.00
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C:onstraction Tay. -
Administrative Fee:
O
O
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
ct St Building or Structure
0
A
Travel Docurnenlalion Fees:
Strong Motion Fee: IBSEISMICR
$1.24
Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.24
$236.00
TOTAL FEE:
$238.24
Revised: 04f01/2015