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B-2016-1395_APP & PERMITCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13-2016-1395 19864 WHEATON DR CUPERTINO, CA 95014-2362 (316 21 085) (SOLARCITY CORPORATION) SAN MATEO, CA 94402 OWNER'S NAME: DATE ISSUED: 02/19/2016 OWNER'S PHONE: 408-332-2043 PHONE NO: 650-477-6430 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INTO: License Class C=10 Lic. #888104 Contractor (SOLARCITY CORPORATION ) Date 02119/2016 X BLDG _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. SOB DESCRIPTION: INSTALLATION (17) ROOFTOP FLUSH MOUNTED SOLAR PANEL I hereby affirm under penalty of perjury one of the following two declarations: (4.42) KW 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 fire work for which this permit is issued. a 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: $10000.00 this permit is issued. APPLICANT CFRTIFICATION 1 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 316 21 085 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. Addlfionall the a licant understands and will comply with all non -point source gula i s per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. 91216 Issued by: ABBYAYENDE e � � �� Signature Date 02/10 Date: 02/19/2016 OWNER -BUILDER DECLARATION 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 live reasons; installed without first obtaining an inspection, I agree to remove all new materials for r. 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 (Sm.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 02/19/2016 contractors to construct the project (Sec.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 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will 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 s. 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 lity M gement District I will maintain compliance with the Cupertino M cipat Q? Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 2 OS 255V , 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: 02/19/2016 APPLICANT CERTIFICATION CO T THIN 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 Code, Section 9.18. Licensed Professional Signature Date 02/19/2016 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIMSION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(acupertino.ci PROJECT ADDRESS I �oyl t/1 r. APNHt j 2.1 S^_ OWNERNAME ifiV PHONE L -Cq EMAIL STREET ADDRESS 1qx f CITY, STATE, Z P Etkoe- FAX CONTACT NAME Marjan Javanmard I I'} IGNE650.477.6430 I E-MAIL mjavanmard@solarcity.com STREET ADDREss391 Foster City Blvd CITY, STATE, "'Foster City, CA 944041FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 9 CONTRACTOR AGENT ❑ ARCERT= ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACPORNAME SoIarCity Corporation LICENSENUMBER00010A`'h LICENSE TYPE ( 10 BUS. LIC N288441 L.(J (J`$ COMPANYNAME SoIarCity Corporation E-MAIL mjavanmard@solarcity.com FAX STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PNGNE650.477.6430 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC ff COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OP SFD or Duplex ❑ Mufti -Family STRU uli.. ❑ Commercial PROJECT W WILDLAND URBAN MTERFACE AREA ❑ Yes ❑ No PROJECT EJ FLOODZONE ❑ Yes ❑ NO SOLAR PANELS 1 ❑ ELECTRICVEIBCLECHARGINGSTATON SOLARWATERFIEATWG ❑ OTEIER: FOR SOLAR PANELS, NUMBER OF PANELSIUNITS: tl•/ KILOWATTS (COMMERCIAL ONLY): IP )r9— TOTAL VALUATION: I©,y 0PC) .OU DESCRIPTION OF WORK Installation (I) rooftop flush mounted solar panel (5,L(&kW By my signature below, I certify to each of the following: I am th roporVVviner or authorized agent to act on the pro e ehalf. I have read this application and the information I have provided is correct. I have ad thp 6scription of Wod<and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building constmction. I a orRw. resentatives of Cupertino to enter the above -identified properJty far inspection purposes. Signature of Applicant/Agent Date: 0) I 716 SUPPLEME THY INFORMATION REQUIRED OFFICE USE ONLY WWw OVER-THE-COUNTER F' ❑ EXPRESS U ❑ STANDARD. U LARGE ❑ MAJOR PVApp_2011.doc revised 03116111