15120112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1022 CRANBERRY DR CONTRACTOR:SOLARCITY PERMIT NO:15120112
OWNER'S NAME: PAPPAS GEORGE L TRUSTEE 3055 CLEARVIEW WAY DATE ISSUED:12/14/2015
OWNER'S PHONE: 4088283245 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
INSTALL(N)ROFTOP MOUNTED SOLAR PV-24 PANELS
License Class(?jr)—,C a 0 Li..# lrr (6.24 KW)AND INSTALL.(N) 125 AMP SUB PANEL
Contractor E01afe iil`k Date } IA i
I hereby affirm that I am lie sed 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:$12500
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 this APN Number:36204055.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IFWORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITBIN 180 DAYS OF PERMIT 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 DAYS FROM LAST CALLED INSPE T N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may ace a against said City in consequence of the Date: WhO15,
granting of this permit. Addition'fly, applicant understands and will comply Issued by:
with all non-point source regul ions the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date I JJ 1'4 Z 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:
I 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)
I,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. 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: 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�rr Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertirfo Mupi pal Code,Chapter 9.12 and
the Health&Safety Code,Sections 2550 X5533 nd 25534.
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 this Owner or authorized agent:.. Date: '. J i /1 5
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 California. If,after making this certificate of exemption,I
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 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 am
COIMMUN€TY DEVELONNIE1 r T DEPART MEQT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERT k 40, CA.95014-3255
Nf`�,
CUPERTINOl (4(35j 111-3228 FAX(403)7177-3,333-buitdina Zamert€no.orq
PROJECT ADDRESS �g
APN 9
OWNERNAME d - PHONE _ �, E-MAIL -
STREET ADDRESS8 4.✓ -...ate-
CONTACT NAME PHONE E-MAIL m avanmard soiarcit
.Marfan Javanmard 650.477.6430 .com @ v
STREET ADDRESS
391 Foster City Blvd CITY,STATE,ZIP Foster City,. CA 944041FAX
❑OWNER 1:1 OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR A CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER. ❑TENANT
CONTRACTOR NAMESolarCity Corporation LICENSENUMBER8881®A LICENSE TYPE C10 BUS.LICh!288 0
COMPANYNAMESolarCity Corporation E-MAILmiiava99nm`lard@SOlarcity✓.com FAX
STREET ADDRESS 391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 P'650.477,6430
ARCHITECT/ENGINEER.NAME LICENSE NUMBER BUS.LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD Or Duplex ❑. Multi-Family PROJECT IN WILDLAND PROJECT N
STR CTURE: ❑ Commercial.
URBAN INTERFACE AREA ❑ Yes - ❑ No FLOOD ZONE ❑ Yes ❑ N0
SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATNG ❑ OTHER:
FOR SOLAR PANELS: NUMBER OFPANELSRJMTS: KILOWATTS(COMMERCIAL ONLI): TOTAj V ATIO
DESCRIPTION OF WORK `�
Installation (ALq ) rooftop flush mounted solar panel kW
RECEIVED BY: `
By my signature below,I certify to each of the following: I am the prop R o r or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read 1, e Dfe°s ption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authord rip ntatives of Cupertino to enter the above-identified propderty for inspection purposes.
Signature of Applicant/Agent: Date: f i
SUPPLEMENTAL-TNFO' AT QUIRED OFFICE USE ONLY
r _
I OVER-THE-COUNTER
t
F ? ❑ EXPRESS
cUa
El STANDARD
U
t ❑ LARGE
MAJOR
PVflpp_2011.doe revised 03/16/11
CITY OF CUPERTINO 00 _
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1022 Cranberry Dr DATE: 12/14/2015 REVIEWED BY: PAUL
FOR APN: 362 04 055 BP#: VALUATION $12,500
*PERNIIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY PENTAMATION
USE: _T I SFD or Duplex PERMIT TYPE: SOLAR-RE
WORK Install N roftop mounted solar PV-24 Panels 6.24 KW and Install N 125 Amp Sub panel
SCOPE
3
.£,f..,. F.33 : _c.= ='1rm b, 111a r Che-,:k Elea Plan Check 0.0 `hrs $0.00
Elec.Permit Fee: IEPERMIT
0.e SOther Elec.Ins 0.0 hrs $48.00
a7-1-1
�3�7d.T..SY 3�. ?
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelintinat information available and are onL an estimate. Contact the De t o1 addit'l info.
FEE ITEMS 6Fee Resolution 11-053 E . 7ff jd/ ) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl.PC Fee: Reg.. 0 OT 0.0 hrs $0.00 $236.00 1PHOTOVRES I Photovoltaic System
PME Plan Check: $0.00 125 amps Electrical
Permit Fee: $0.00 $48,00 1BELEC200 Services
Suppl. Insp.Feer Reg. Q OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.00
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes � No $0.00
Advanced Planning Fee: OLOE. Select a Non-Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC $48.00 I== A
Strong Motion Fee: 1BSEISMICR $1.63 Select an Administrative Item
Bldg Stds Commission Fee: iBCBSC $1.00
S BTOTA $143.63 $284.00
TOTAL,FEE: $427.63
- LS
Revised: 10/01/2015