15110021CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19759 LA MAR DR
CONTRACTOR: SOLARCITY
PERMIT NO: 15110021
OWNER'S NAME.. LI RICHARD C AND INGRID S TRUSTEE
3055 CLEARVIEW WAY
DATE ISSUED: 11/04!2015
OW)QER'S PHONE: 4086216448
SAN MATEO, CA 94402 PHONE NO: (650) 638-1028
u LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License ClassC t {_ (jam` (� Lie.
INSTALL 11 ROOF TOP, FLUSH MOUNTED PV MODULES (2.86 kW)
,.1.
Contractor L4� I4�Y i. `� Date_L__j
I hereby affirm, that I am licensed der the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and Ghat. 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: $6000
I have and;wiil maintain Worker's Compensation Insurance„ as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36910024.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes, (We) agree to save
ISO D LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may crue against said City in consequence of the
granting of this permit. Addy ally a applicant understands and will coin
y: Date:
with all non -point source re.' atioris er the Cupertino Municipal Code, ect n
9.18. ;
Signature .�, ,
j Date
E -ROOFS:
f
All roofs shall be inspec r to any roofing material being installed. If a roof is
installed without firi4tigning an inspection, I agree to remove all new materials for
inspection.
❑ "OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:.
I, as owner of the property, or'my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (Sec. 70-44,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (See.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
I have and`will maintaina Certificate of Consent to self -insure for Worker'smaterial.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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 Apr Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertind Munropal Code, Chapter 9.12 and
I have andwill maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505 33 nd 25534.
Section 3700 of the Labor Code,'for the erformance of the work for which this
P
permit is issued
Owner or authorized agent: t Date: t l Lt f�
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 -
t
CONSTRUCTION LENDING AGENCY
Compensation laws.of California. If, after making this certificate of exemption, I
become subject to the Worker'sCompensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith domply'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 ML
'1RF NUE �PERT !NO, AE
2z"; F, "'A' 40� buiWing �k
PROJECT ADDRESS 0 151 APN 9
OWNER NAME PHOI, M
0 CIT ILA Li T
STREET ADDRESS I STATE, ZIP FAX
Y . . Pf11'e'\0 5 1
CONTACT NAME F -MAIL
Marjan Javanmard PHONE 650.477.6430 mjavanmard@solarcity.com
STREET ADDRESSCITY, STATE, ZIP FAX 1 1
391 Foster City Blvd Foster City, CA 94404
F1 OWNER D OWNER -BUILDER 0 OWNERAGENT El CONTRACTOR 9 CONTRACTOR AGENT E1 ARCHITECT 1-1 ENGINEER 11 DEVELOPER 0 TENANT
CONTRACTORNAIME
SolarCity Corporation
LICENSE NUMBER
888104 T
LICENSE TYPEC10 10
BUS.
L`28840
COMPANY NAME SolarCity Corporation
I-MILmjavanmard@solarcity.com
FAX
STREET ADDRESs391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PHONE650.477.6430
ARCH1TECT/ENGfNEER NAME
LICENSE NUMBE
BUS. LIC hP
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
L
CITY, STATE, ZIP PHONE
USE OF SFD or Duplex 0 Multi -Family
PROJECT IN WILDLAND PROJECT IN
STRUCTURE: El Commercial
URBAN INTERFACE AREA El Yes E] No FLOOD ZONE [I Yes El No
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING
STATION
El SOLAR WATER HEATING
El OTHER:
FOR SOLAR PANELS. NUMBER OFPANELSIUNITS: lk
KILOWATTS (COMMERCIAL ONLY): c.
TOTAL VALUATION- '$
DESCRIPTION OF WORK
Installation ( kk) rooftop flush mounted solar panel kW
By my signature below, I certify to each of the following. I amlt e owner or auih—or—d agent to aQLawtffF`proagry
j*090's behalf. I have read this
application and the information I have provided is correct. I a' read t -Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I or- epresentatives of Cupertino to enter the above -identified property. for inspection purposes.
Signature of Applicant/Agent: Date: k� 10
STJPPL0,ffiNTAk1NF0RMATI0N REOUIRED 0FRWE USE ONLY
El P--.\Ppxss
El STANDARD
❑ LARGE
Ca
0 MAJOR
P VApp_201 Ldoe revised 03116111
CITY OF CUPERTINO
FEW FEE ESTIMATOR — BUILDING DIVISION
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctrirt_ etc )_ These lees are based an the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 LCL 711113)
ADDRESS: 19759 LA MAR DR
DATE: 11/04/2015
REVIEWED BY: MELISSA
[_
APN: 369 10 024
BP#:
`VALUATION: $6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: 0 Reg. Q OT
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORKINSTALL
11 ROOF TOP FLUSH MOUNTED PV MODULES 2.86 k
SCOPE
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctrirt_ etc )_ These lees are based an the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 LCL 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: 0 Reg. Q OT
FO.0 I
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. FeeQ Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C,'r�rr.;lruc'dt,�yt Ta.�:
:�lrrirrrrstrairvr 1,,,�,.
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
A
-fro-0-E1 Dc�t.�uirrE:rrt�rtir;,< <� �; .,
Strong Motion Fee:
IBSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:$1.78
$236.00
TOTAL FEE:
$237.78
Revised: 10/01/2015
CUPERTINO
Address I l `
PURPOSE
SMOKE l CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE I LE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONIL7�,I(T
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org _
/(�/% r�-- Permit No.
l V RC1 Y # of Alarms Smoke: � -" Carbon Monnxide-
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNEJ2 AND REfIEN sD TO THE BUILDING DIVISION
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bumulg appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to combly with the terms and conditions of thirstatement
Owner (dt OWW AgK Ws) Name' �
�lr
S' ntUre.... :,..... `cam .................... .L...... ............... s ....:.........f..
Con0kf6r am e:
Sipttee...................................................................L94...................................... Date:...................
Smoke and CO forni.doc revised 03/18/14
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
le
OWNER CERTIFICATE OF COMPLIANCE �,.
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (4D8) 777-3333 • buildingoDcupertinc.org
Permit No. l
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
5 No Go to Question 2.
r;
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
lei Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form. r` l
Q No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
V No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
M Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
f /
Please check ONE of the following: Y'' t t�(
[V My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the w,r cerving plumbing fixtures comply with the requirements as indicated in the
table on the following page. _ o�
Owner or Owner Agent's Signature: ," "��L(—�- Date:
�C T
Upon completing and signing this CertfiCate, please return it to the Bwldin Msicn in order to final your bu' ding permit.
SB407 2015.doe revised 08126115
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