15120066CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19900 PRICE AVE CONTRACTOR: SOLARCITY PERMIT NO: 15120066
OWNER'S NAME: KWOK EDWARD C AND IRENE L TRUSTEE 3055 CLEARVIEW WAY
DATE ISSUED: 12/08/2015
O ER'S PHONE: 4082578308 SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
Er LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL R
License Class QQQ Lic.:#
i INSTALL 23 ROOF TOP, FLUSH MOUNTED PV MODULES
C� ft (5.98KW)
Contractor. �Gl j j Date ( � IS
I hereby affirm that I am li 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: $13000
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
permit is issued. APN Number: 36904029.00Occupancy 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 180 D SIVROIVLL&WALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which ma ccrue against said City in consequence of the
granting of this permit. Add: 'onally e applicant understands and will com Date:1
with all non -point source r ' ulatiops er the Cupertino Municipal Code, Secti
9.18. /
Signature t� RE -ROOFS:
Date 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
OWNER -BUILDER DECLARATION inspection..
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. 1 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 1 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 it Qu ty Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cuperti Mun al Code, Chapter 9,12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550 , 2553 nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.. Owner or authorized agent: Date: 12,10
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 CONSTRUCTION LENDING AGENCY
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
CITY OF CUPERTINO
FEE ESTIMATOR BUILDING DIVISION
ADDRESS: 19900 PRICE AVE DATE: 12/08/2015 REVIEWED BY: MELISSA
APN: 369 04 029
. BP#: *VALUATION: $13,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex PENTAMATION
. I — PERMIT TV13P - SOLAR -RES
WORK [INSTALL 23 ROOF TOP, FLUSH
SCOPE I
h.
ES
NO . TE. . This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District,
Ifml, u . inese reesare Daseyonthe reaminar !nf,)rmatio"available and are q Z 4— 0- �11_ I
Q
FEE ITEMS (Fee Resolution 11-053 Eff.'711113)
FEE
QTY/FEE
-Z--
a mact the Dept,Lur auurt I myu.
MISC ITEMS
Plan Check Fee:
$0.00
1 # Alternative Energy System
$236.001 IPHOTOVRES I Photovoltaic System
Suppl. PC Fee: Q) Reg. 0 OT[7001
firs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg, 0 OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
F7
_4 in z,f r4di vvfy 'ee:
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building
Bung or Structure
G
0
es:
Strong Motion Fee: IBSEISMICR
$1.69
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.001
SIIBTOTALS,
$2.69
$236.0R,
Ef.
$238.6�
Revised: 10/01/2015
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPART T - c.!Il_DiNG DIVISION
10300 TRE AVENUE • CUPERTINO, CA 9501`x- _25`
(40 8) 777-3228 - FAX (4-08) 7 77-3333 s bul;d€ I_Qzcu yet
PROJECT ADDRESS p� p
j/�- q0c) i t,L_e_ i
OWNER NAME
STREET ADDRESS
CONTACT NAME Marjan Javanmard
STREET ADDRESS 391 Foster City Blvd
APN # 0((_
L_ D 2
PHONE i- `z :s C%