15080178-CANCELLEDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10595 CULBERTSON DR
CONTRACTOR: SOLARCITY
PERMIT NO: 15080178
OWNER'S NAME: WONG HON YUNG AND WOO MAN-YEE CATHE
3055 CLEARVIEW WAY
DATE ISSUED: 08/25/2015
OW ER'S PHONE: 5105013919
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL 0
LICENSED CONTRACTOR'S DECLARATION
INSTALL 20 ROOF TOP, FLUSH TOP PV MODULES (5.2
License Class . 0 Lic. # s s s 109
KW
Contractor G` ✓lam i Date 6 AS
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.
Sq. Ft Floor Area:
Valuation: $11000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37536023.00
Occupancy Type:
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
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
180 D LED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmleeCity of Cupertino against liabilities, judgments,
._ -- — ___ __ _..
0-i
and expenses which ccrue a 'nst said City in consequence of
Da
costs,
Issued b
granting of this permit. Adally, applicant understands and willc mply
with all non -point source ions r the Cupertino Municipal Code, Section
9.18.
5
" '
RE -ROOFS:
inspected to any roofing material being installed. If a roof is
Signature Date
All roofs shall be prior
for
installed without first obtaining an inspection, I agree to remove all new materials
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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
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 or devic which emit hazardous
defined by the Bay Are it Qualt Management District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
of the work for which this permit is issued.
air contaminants as
will maintain compliance with the Cup o1um i I Code, Chapter 9.12 and
performance
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sections 2550 ,'�� d 25534.
/
Section 3700 of the Labor Code, for the performance of the work for which thisOwner
or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
t
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
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
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
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
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
ALTERNATIVE ENERGY PERMIT APPLICATION
't.r ,;iso, �lkwi�? f•�.�_G i!I'vilIv1
�'EN C U 40,. C', A �5, 2 AE
�5 a 0 !
PROJECT ADDRESS 10,5e(5 % Y� �� t u..
66� C �,J
AP9 r
Q
OWNER NAME 1. t ` I V ���
a_. V\
PHONE c-' C," C
telC,-"5C)I-�>�6
E-MAIL
STREET ADDRESS ii CITY, STATE, ZIP, C , L FAX
CONTACT NAME Marjan Javanmard PHONE 650.477.6430 E-MA1Lmjavanmard@solarcity.com
STREETADDRESS3�r91 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 NAME LICENSE NUMBER 888104 LICEN,SETYPECIO BUS. LIC
SoIarCity Corporation
COMPANY NAMESolarCity Corporation
E-MAIL mjavanmard@SolarCity.COM
FAX
STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404
PHONE650.477.6430
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC u
COMPANY NAME .
E-MAIL
FAX
STREET ADDRESS, ! CITY, STATE, ZIP PHONE
%
USE OF q S/FD or Duplex ❑ Multi -Family PROJECT LSI WILDLAND PROJECT IN
L
STRU . URE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 00KILOWATTS (COMMERCIAL ONLY): r i9
1
TOTAL VALUATION
A 11ro 0C,
DESCRIPTION OF WORK
Installation rooftop flush mounted solar panel kW
By my signature below, I certify to each of the following: I am the pro�}%rty o.� r or authori c o e property owner's behalf. I have read this
j
application and the information I have provided is correct. I have rel the Des iption of Work and verify it is accurate. I agree to comply with all applicable local
l
ordinances and state laws relating to building construction. I authofize r6pr sentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ��- — — _�._._ Date:
SUPPLEMENTAIJYFIORMATION REQUIRED
OrrICE USE ONLY
❑ OVER -THE COUNTER
❑ EXPRESS
U
x
❑ STANDARD
U
❑ LARGE
C,
❑ MAJOR
PV4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Ge. Piammng, ruouc works, rire, ounuury —w- Lwu ws, �C.......
bd #Z.1'mina in ormation available and are onl an estimate. Contact the De t or addn'l in o.
District, maj. These Lees are as on a re r
FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/13)
ADDRESS: 10595 CULBERTSON DR
DATE: 08/25/2015
REVIEWED BY: MELISSA
tlech. Permit Fee:
APN: 375 36 023
BP#:�g
*VALUATION: $11,000
*PERMIT TYPE:. Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
ldaclz. lash. Fee:
PENTAMATION SOLAR -RES
PERMIT TYPE: i
WORK
INSTALL 20 ROOF TOP FLUSH TOP PV MODULES 5.2 k
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (Ge. Piammng, ruouc works, rire, ounuury —w- Lwu ws, �C.......
bd #Z.1'mina in ormation available and are onl an estimate. Contact the De t or addn'l in o.
District, maj. These Lees are as on a re r
FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/13)
,llech. Plan Check
Phutrb. Plan Check
Elec. Plan Check
tlech. Permit Fee:
Plumb. Permit Yee:
Flee. Permit Fee:
OtJ�c+ A,kwh. Insp.
Other Plumb Insp.ED-L-
Ocher Z-.7ec. Ins'r.
ldaclz. lash. Fee:
Plumb. Insp. Fee:
G ec. Insp. Yee:
Permit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (Ge. Piammng, ruouc works, rire, ounuury —w- Lwu ws, �C.......
bd #Z.1'mina in ormation available and are onl an estimate. Contact the De t or addn'l in o.
District, maj. These Lees are as on a re r
FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
# Alternative Energy System
$236.001 IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Supp/. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
-T-7=_
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tar:
Administrative Fee:
C)
E)
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure C)
Trm,el Dveu7nen1a1iOn Fees:
Strong Motion. Fee: IBSEISMICR
$1.43
Select an Administrative Item -
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:_
$2.43
$236.00
$238.43
Revised: 07/02/2015