15090134-DP PUB10596 J O H N WAY
15090134
F/P
WU KUO-LIANG AND SHIER
SHEAU-HUE
SCANNED BOX #663
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10596 JOHN WAY I CONTRACTOR: SOLARCITY I PERMIT NO: 15090134 1
OWNER'S NAME: WU KUO-LIANG AND SHIEH SHEAU-HUE 13055 CLEARVIEW WAY I DATE ISSUED: 09/21/2015 1
PHONE: 4088430856
LICENSED CONTRACTOR'S DECLARATION
License Class (? 1 o.r C `al—ia Lie. # U e I O Lt
Contractor p ( ) Date q 9✓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:
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
performance of the work for which this permit is issued.
2. 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
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 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
indemnify and keep harmless [ my of Cupertino against liabilities, judgments,
costs, and expenses which ma ecru gains[ said City in consequence of the
granting of this permit. Add'�'onal a applicant understands mid will comply with
all non -point source regale' p e Cupertino Municipal Code, Section 9.18.
Signature / "' - Date II AS
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 1, 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)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of Ore Labor Code, for the performance of the work for which this
permit is issued.
3. 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
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 forthwith comply with such provisions or this permit shall be deemed
revoked.
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
SAN MATEO, CA 94402 1 PHONE NO: (650) 638-1028
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL(N)ROOFTOP SOLAR PV- I I PANELS(2.a6 KW)
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 35918004.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D S FROM`(( (LAS�T�CALLED
Issued by: �oU�""f Date: q
RE -ROOFS:
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.
Signature of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance wjj'th the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Cod ''{Sectiq s 5505, 25533, and 25534.
Owner r-rnth 'Owner r e�i ..// I _ Date:
i
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Nnine
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO
ALTERNATIVE ENERGY PERMITAPPLICATION
WN041LINITY DEVELOPMENT DEPARTMENT � R(ALdS NG i?rN04lliIMA
i0300TORRF AVENUE • CUPE.RTINO, f;.A g5014-32.5 ,
AE
,MOT) j/ � Y
777-3228 • FAX (408) 777-3333 • bDxBdileo i gyp'. mq.Q 7 W Q�
PROJECT ADDRESS E J'� S 01 � V ' 1 C� APN M
t/ Y� r'�/
OWNLQ_1 , iC,� C �_ Pilo E-MAIL
I`/AUC�()��
STREET ADDRESS 10
cE.u, ATE r�I\oJJ O I
FAX
CONTACT NAME Marjan JavanmardhJ
F'ONE650.477.6430
E-MATL mjavanmard@solarcify.com
STREET ADDRESS391 Foster City Blvd
CITY, STATE, ZIP Foster City CA 94404
ll❑
FAX
OWNER ❑ OWNER-BUa.DER ❑ OwNER AGENT CONTRACTOR O CONTRACTOR AGENT ARCMTECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME SolarCity Corporation
LICENSENUMBER
88810A
LICENSE TYPE/" 10
BUS. LICk2U00AQ
V�-P
COMPANY NAMESolarCity Corporation
I-IlLmjaUvVanmard@solarcity.com
FAR
STREET ADDRESS391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PNONE650.477.6430
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LTC #
COMPANY NAME
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
use OF SFD or Duplex ❑ Mtllfi-Fflmlly
STR CTURE: El Commercial
PROJECT Gl 4VILDLANO
URBAN INTERFACE AREA El Yes El No
PROJECT IN
FLOOD ZONE [I Yes El No
SOLARPANELS
ELECTRICV11CLECHARGINGSTATION
❑ SOLAR WATER HEATMG
Ll OTHER'.
FOR SOLAR PINELS: NUMBER OF PANELSIUMTS: \\ KILOWATTS (COMMERCIAL ONLY): a B�
u�AnnG
TOTAL VALUATION'
f'1
DESCRIPTION OF WORK
Installation (t1) rooftop flush mounted solar panel O kW
RECEIVBDBY.
By my signature below, I certify to each of the following: I am the pr erly,alDer ar authorized agent to ael on the property owner's behalf f have read this
application mud the information 1 have provided is correct. I have rea the bription ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constmction. I authorniep entatives of Cupertino to enter the above-irlenfified propert for inspection purposes.
SigiatureofApplica t/AgenC (f Date' !1
SUPPLEMENTAIUN-F6RMAT1b1V-RL.QUIRP.D
_
- ocFiCEUSE ONLY
Per..
1
U
U
O
OVER-THE-COUNTER
❑ EXPRESS
❑ .STANDARD
❑ LARGE
❑ MAJOR
PVilpp20H,doc.revrsedWWI?
CITY OFUPERTINO
Il FEE ESTIMATOR-
��BUILDING DIVISION PCq O13`i `
JAFADDRESS:
10596 John Way
DATE: 09/21/2015
REVIEWED BY: PAUL
APN: 359 18 004
BP#:
'VALUATION: $6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
I PERMIT TYPE:
WORK
Install N rooftop solar PV - 11 Panels 2.86 K
SCOPE
:lfech. Plan Check
Plreob. Plan Chec%
Eke. Plan Check
Mech. Pennnil Pee:
Plumb, Permit Fee:
131ecc Perniir Fee:
OInter Alcch. lrup-
Other Plumb frrsp-
Other Etec•. Insp.
Vech, bup. Fee:
111miA Lap. Fee:
Etec. Imp. hee..
NOTE: This estimate does not include fees due to other Departments (I e. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtrict. etc. ). These fees are based on the nreliminary information available and are only an estimate. Contact the Deal for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 L ' 7/1/13,1
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$236.00
Alternative Energy System
1PHOTOVRES Photovoltaic System
Suppl. PC Fee: 0 Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. 0 OT
0.0
1 Ins
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Doeurnentatirn Fees:
Strong Motion Fee: IBSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:`
$1.781
$236.001
TOTAL FEE:
$237.78
Revised: 07/02/2015