B-2016-1260 Application, Permit & Fee EstCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1260
21144 LAURETTA DR CUPERTINO, CA 95014-1657 (326 54 023)
(SOLARCITY
CORPORATION)
SAN MATEO, CA 94402
OWNER'S NAME: LIU TOM T AND CHRISTINA S
DATE ISSUED: 01/26/2016
OWNER'S PHONE: 408-255-0481
PHONE NO: 650477-6430
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C_10 Lie. #888104
Contractor ( SOLARCITY CORPORATION ) Date 01/26/2016
X BLDG X ELECT —PLUMB
'
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL 8 ROOF TOP, FLUSH MOUNTED PV MODULES (2.08kW) &
I hereby affirm under penalty of perjury one of the following two declarations:
UPGRADE MAIN ELECTRIC PANEL TO 125 AMPS (SAME LOCATION)
r. 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.
16 z. 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
Sq. Ft Floor Area:
Valuation: $4500.00
this permit is issued.
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
326 54 023
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, costs, and
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulaijoiris per the Cupertino Municipal
110 DAY ,- LED INSPECTION.
Code, Section 9.18.
Signature Date 01/26/2016
Date: 01/26/2016
OWNER-BUH.DEIC 'CLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed, If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
a. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec,7044, Business & Professions Code)
Signature of Applicant:
a. I, as owner of the properly, am exclusively contracting with licensed
Date: 01/26/2016
contractors to construct the project (Sce.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
a. 1 have and will maintain a Certificate of Consent to selfinsum for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which thus permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
z. 1 have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I wild
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health &Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air uali Management District I
will maintain compliance with the Cupertino mci a Cade, Chapter 9.12 and
Worker's Compensation laws of California, If, after making this certificate of
the Health & Safety Code, Sections i505 533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:
be deemed revoked.
Date: 01/26/2016
APPLICANT CERTIFICATION
CONST4fKeTT0N LENDING AGENCY
I certify that I have read this application and state that the above information Is
I hereby affirm that there Is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for Inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Cade, Section 9.18.
Licensed
Professional
Signature Date Oil26/2016
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
(C)NINIONIlY DEVELOPMENT DEPARTMENT R4IPu..i3lNG II)AMS;ION
vn3,L) TORRF AVENUE • CUPI R-TINO. GA!W14-326.F AE
0,4vt3) —7-3<^.20 • FAX (406) 777-3333 , bufldd 4 __k eurnml
(3- 2616
PROJECT ADDRESS �i1 /, I I � , �.,I� � �Y.
APNN %I. �1 /� -4 _V3,
J`MAIL
OWNERNAME TOvy`�
1 J`y
v
STREET ADD S
N
avYe fta 1�r.
CTTY, STA�,Z[PI O �� t I
cW <
FAX
CONTACT NAME Marjan Javanmard
Ptl N8650.477.6436
E-MAIL mjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
El OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR O CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME SolarCity Corporation
LICENSENUMBER 888104
LICENSE TYPE10
BUS, LIC R2OOAUC➢`f1-e•'-'
COMPANY NAME SolarCity Corporation
E-MAILmjavanmard@solarcity.com
I
STREET ADE)"'391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
""650.477e6430
ARCFITECTIENGMEER NAME e
LICENSE NUMBER
BUS. LIC0
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD Or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WN,I)LAND
URBAN ERFACEAREA ❑ Yes ❑ No
PROJECT W
FLOOD ZONE ❑ Yes ❑ No
SOLAR PANELS
LI ELECTRIC VEFECLE CHARGING STATION
❑ SOLAR WATER WAITING
El OTFB?R:
FORSOLARFA,VELS: NUMBER OF PANELS/UMTS: KILOWATTS (COMMERCIAL ONLY):
JAL LUATION'
•n
DESCRIPTION OF WORK
Installation ( ) rooftop flush mounted solar panel (z,a,) kW
J�N-Li �t1`S Atc) na'n S-y-VICE PAnC
RHCCIVEDBY
By my signature below, I certify to each of the followf J IF the property, owner or authorized age o ac e property oW ,� e alf, ave rea his
application and the information I have provided is aQ'rect///. I ave read the Description of Work an It is accurate. I�gx o col I with all a ble local
ordinances and state laws relating to building con tftiL,{'in}l. I authorize representatives of Cupertino to enter the above-idenh, perry for' ctiou purposes.
Signature ofApplicanVAgent // Data: O
SqPPL MENTAL INFORMATION REQUIRED
OCRICR USE_ONLY
yUy
q
El OVER -THE COUNTER
DXPECSS
❑ STANDARD
El
_.
0.
❑ MANOR
_ _ Mpp 2011.docrevised03116111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21144 LAURETTA DR
DATE: 01/26/2016
REVIEWED BY: MELISSA
APN: 326 54 023 BP#:
VALUATION: $4,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
PENTAMATION SOLAR -RE
USE:
PERMIT TYPE:
WORK
IN 8 ROOF TOP FLUSH MOUNTED PV MODULES & UPGRADE MAIN ELECTRIC PANEL
SCOPE
TO 125 AMPS (SAME LOCATION)
Medr. Tian
Plmub. Mir; Check
Flee. Plan Check 0.0 hrs $0.00
A ei ,,,k Perrur [ee:
Piwnn. ;'mr;rtir F'1,e;
Elec. Permit Fee: mPERMIT
t3ih�=r tla,h. 1n.;P.
CJrher^1'Irmrh Insr=.
Other Elec. Insp. 0.0 hrs $48.00
;i9ectr. Irs7z hea
1'lurr:h. lnsla P4e:
E7�=c. tnxp. Vet',
NOTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Pyre, Sanitary Sewer District, School
District, etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution I1-053 ETf. 711113,i
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
IP110TOVRES Photovoltaic System
Suppl. PC Fee: (F) Reg. 0 OT
Q•0 T
hrs
$0.00
PME Plan Check:
$0,00
F125amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
p,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
(onstruclion ILtd°.
Administrative Fee:
1ADMIN
$45,00
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee:
1RSEISMICR
$0.59
Select an Administrative Item
131de Stds Commission Fee: 1BCasC
1 $1.00
SUBTOTALS:'
$142.59
$284.00
. TTAI711 j
$426.59
Revised: 01 /01 /2016