15050038 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:05/07/2015
OWNER'S PHONE: 4089738832 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
INSTALL 16 ROOF TOP,FLUSH MOUNTED PV MODULES
Ci
l� License ClassO,g (,21) Lic.# `kms Cp,?�o q (4.16 KW)
(� Contractor S"A 6�`( � i Date r 1
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:$9500
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 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 WITIIIN 180 DAYS4WT1MMIT 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 D OM ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which in accrue against said City in consequence of the
granting of this permit. Add-t, aly},the applicant understands and will comp y ate:
with all non-point source reg lati6ps per the Cupertino Municipal Code,Section
9 18.
.% RE-ROOFS:
Signature ! - Daten,s([Q�15 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:
1 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. 1 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 Area Ai Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino nici 1 Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 3,an 25534.
Section 3700 of the Labor Code,for theerformance of the work for which this s
p Owner or authorized agent: (� 4 Date:J
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
CONSTRUCTION LENDING AGENCY
Compensation laws of Califomia. If,after making this certificate of exemption,1
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 1 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 Ob
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300-TORRE AVENUE•CUPERTINO, CA 05014-3255 AE
CUPERTINO (408)777-3228 • FAY,(408)777-:3333 •buildingcDcupertino.osa
PROJECT ADDRESS `� I-t�) -}- APN#
OWNERNAME '1/ �'\1 I PHONE — �� , E-MAIL 6
J C
STREET ADDRESS CI ,ZIP.I0 J 1, r 1S � T th,-\0 I 0 t FAX
CONTACT""Marian Javanmard PHONE 650.477.6430 E-MA`Emjavanmard@solarcity.com
STREETADDRESs391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR Y❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMESoIarCity Corporation LICENSENUMBER888104 LICENSE TYPE C10 BUS.LIC 428840
COMPANY NAMESoIarCity Corporation E-MAlLmjavanmard@solarcity.com FAX
STREETADDRESS391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 ""650.477.6430
ARCHITECT/ENGPIEERNAME LICENSENUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGNG STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: ( KILOWATTS(COMMERCIAL ONLY): t TOTAL VALUATION- OJ C) v
`I l�
DESCRIPTION OF WORK
Installation (j(, rooftop flush mounted solar panel kW
/ l
B m Signature below,I certify to each of the following: I am the prop r or authorized agent to act n the roe owner's a read this
Y Y g fY a P P o property�Y
application and the information I have provided is correct. I have read t scription of Work and verify it is omply with all applicable local
ordinances and State laws relating to building construction. I authorize pr sentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Appl icant/Agent: Date: C? Z0
SUPPLEMENTAL INFORMATION REQUIRED ��' 77
7 sr t u rY) ,t,AFF7(E USE,O}YLYi (i,,
Y f"fIS�F "N")
w�S�Ii �,❑rrOVE11ti C YY�JNTER
Fil �b 11�,Y i
i x,nl Lb,ds IEXPI2CSS?1,����x I,St it 11 i!S
�, a ,y❑�L.�,IYGC�
I❑ MAJOR
PVApp_201I.doc I•evised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
QkADDRESS: 10353 MIRA VISTA DR DATE: 05/07/2015 REVIEWED BY: MELISSA
N: 357 02 041 BP#: � Q0� *VALUATION: $9,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION SOLAR-RES
USE: SFD or Duplex PERMIT TYPE:
WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.16 k
SCOPE
I
p
,22liv!
�y . r� ��.:. _ h El�u } �` > 1..9:_v. r R:'bi4�ir 1l
a1ldreo-'ccJh�l,r..rF l.rtz�osC�lrt(hihcee:ca:
k
teu
htom.'Pe,rmIiPl Fee:
e2•etr
1i)i'➢h�Ihu.eri rf-ht.i 5 lPhx lncSnIrI,rT.ath�(i!l'rrt"frJs�=t;�a).c u..! lr �� 1i��7 + 1Oth'teYr'3O� cc7. l
spr
.
Othrrlrrllnsn !Jec. l ":
P!ttrl. Irsh. ( rc:
NOTE:This estimate does not incudefees due to other Departments(Le.Planning,Public Works, Fire,Sanitary
riS}�etwier�District,
School
oo
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 Eff. 711113) FEE QTY/FEE
MISC ITEMS
Plan Check Fee: $0.00 1 # Alternative Energy System
Suppl.PC Fee: Q Reg. Q OT 0.0 ht's $0.00 $236.00 .IPHOTOVRES Photovoltaic System
PME Plan Check: $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'unstrttc•lion Tax
0
ldtninisdc.ttiva Fee: 0
Work Without Permit? 0 Yes Q No $0.00
Select allon-Residential &
Advanced Planning Fee: $0.00
Building or Structure 0
i
Trim-c'l Dnc:•l.ttnctnlalirni h"Ce.5': _T_=
Strong Motion Fee: IBSEISMICR $1.24
Select an Administrative Item
Bldg Stds Commission Fee IBCBSC $1.00 K
t
i $UBTO'LA�S
$2
$2.24 36 00 k OTAL.
T FEE $238.24
Revised: 04/01/2015
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:05/07/2015
OWNER'S PHONE: 4089738832 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
INSTALL 16 ROOF TOP,FLUSH MOUNTED PV MODULES
Ci
l� License ClassO,g (,21) Lic.# `kms Cp,?�o q (4.16 KW)
(� Contractor S"A 6�`( � i Date r 1
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:$9500
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 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 WITIIIN 180 DAYS4WT1MMIT 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 D OM ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which in accrue against said City in consequence of the
granting of this permit. Add-t, aly},the applicant understands and will comp y ate:
with all non-point source reg lati6ps per the Cupertino Municipal Code,Section
9 18.
.% RE-ROOFS:
Signature ! - Daten,s([Q�15 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:
1 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. 1 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 Area Ai Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino nici 1 Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 3,an 25534.
Section 3700 of the Labor Code,for theerformance of the work for which this s
p Owner or authorized agent: (� 4 Date:J
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
CONSTRUCTION LENDING AGENCY
Compensation laws of Califomia. If,after making this certificate of exemption,1
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 1 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 Ob
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300-TORRE AVENUE•CUPERTINO, CA 05014-3255 AE
CUPERTINO (408)777-3228 • FAY,(408)777-:3333 •buildingcDcupertino.osa
PROJECT ADDRESS `� I-t�) -}- APN#
OWNERNAME '1/ �'\1 I PHONE — �� , E-MAIL 6
J C
STREET ADDRESS CI ,ZIP.I0 J 1, r 1S � T th,-\0 I 0 t FAX
CONTACT""Marian Javanmard PHONE 650.477.6430 E-MA`Emjavanmard@solarcity.com
STREETADDRESs391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR Y❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMESoIarCity Corporation LICENSENUMBER888104 LICENSE TYPE C10 BUS.LIC 428840
COMPANY NAMESoIarCity Corporation E-MAlLmjavanmard@solarcity.com FAX
STREETADDRESS391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 ""650.477.6430
ARCHITECT/ENGPIEERNAME LICENSENUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGNG STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: ( KILOWATTS(COMMERCIAL ONLY): t TOTAL VALUATION- OJ C) v
`I l�
DESCRIPTION OF WORK
Installation (j(, rooftop flush mounted solar panel kW
/ l
B m Signature below,I certify to each of the following: I am the prop r or authorized agent to act n the roe owner's a read this
Y Y g fY a P P o property�Y
application and the information I have provided is correct. I have read t scription of Work and verify it is omply with all applicable local
ordinances and State laws relating to building construction. I authorize pr sentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Appl icant/Agent: Date: C? Z0
SUPPLEMENTAL INFORMATION REQUIRED ��' 77
7 sr t u rY) ,t,AFF7(E USE,O}YLYi (i,,
Y f"fIS�F "N")
w�S�Ii �,❑rrOVE11ti C YY�JNTER
Fil �b 11�,Y i
i x,nl Lb,ds IEXPI2CSS?1,����x I,St it 11 i!S
�, a ,y❑�L.�,IYGC�
I❑ MAJOR
PVApp_201I.doc I•evised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
QkADDRESS: 10353 MIRA VISTA DR DATE: 05/07/2015 REVIEWED BY: MELISSA
N: 357 02 041 BP#: � Q0� *VALUATION: $9,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION SOLAR-RES
USE: SFD or Duplex PERMIT TYPE:
WORK INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.16 k
SCOPE
I
p
,22liv!
�y . r� ��.:. _ h El�u } �` > 1..9:_v. r R:'bi4�ir 1l
a1ldreo-'ccJh�l,r..rF l.rtz�osC�lrt(hihcee:ca:
k
teu
htom.'Pe,rmIiPl Fee:
e2•etr
1i)i'➢h�Ihu.eri rf-ht.i 5 lPhx lncSnIrI,rT.ath�(i!l'rrt"frJs�=t;�a).c u..! lr �� 1i��7 + 1Oth'teYr'3O� cc7. l
spr
.
Othrrlrrllnsn !Jec. l ":
P!ttrl. Irsh. ( rc:
NOTE:This estimate does not incudefees due to other Departments(Le.Planning,Public Works, Fire,Sanitary
riS}�etwier�District,
School
oo
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 Eff. 711113) FEE QTY/FEE
MISC ITEMS
Plan Check Fee: $0.00 1 # Alternative Energy System
Suppl.PC Fee: Q Reg. Q OT 0.0 ht's $0.00 $236.00 .IPHOTOVRES Photovoltaic System
PME Plan Check: $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'unstrttc•lion Tax
0
ldtninisdc.ttiva Fee: 0
Work Without Permit? 0 Yes Q No $0.00
Select allon-Residential &
Advanced Planning Fee: $0.00
Building or Structure 0
i
Trim-c'l Dnc:•l.ttnctnlalirni h"Ce.5': _T_=
Strong Motion Fee: IBSEISMICR $1.24
Select an Administrative Item
Bldg Stds Commission Fee IBCBSC $1.00 K
t
i $UBTO'LA�S
$2
$2.24 36 00 k OTAL.
T FEE $238.24
Revised: 04/01/2015