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15090156-VOID CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10784 W ESTATES DR CONTRACTOR:SOLARCITY PERMIT NO: 15090156 OWNER'S NAME: BOPINI SATHISH AND RENGASAMY PRETHI 3055 CLEARVIEW WAY DATE ISSUED:09/23/2015 OWNER'S PHONE: 4088933333 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ® COMMERCIAL Q INSTALLATION 13 ROOFTOP FLUSH MOUNTED SOLAR PANELS License Class_+-j(�JLic.#_ �J ( 3.38KW Contractor Co(C--i} Date_ �( f' I hereby affirm that I am license der 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:. Sq.Ft Floor Area: Valuation:$7000 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 APN Number:36922032.00 Occupancy Type: 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that 1 have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued b � Date: "( indemnify and keep harmless thq City of Cupertino against liabilities,judgments, costs,and expenses which may ccrue against said City in consequence of the granting of this permit. Add-' nally`,/ihe applicant understands and will comply with RE-ROOFS all non-point source re at' a Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date I( installed without first obtaining an inspection,I agree to remove all new materials for inspection. 13 OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as deft.*' by the Bay Area Air Quality Management District I will Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance lith the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety ,Secons ns 25505,25533,and 25534. performance of the work for which this permit is issued. ' 2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner ont: ®® � i Section 3700 of the Labor Code,for the performance of the work for which this Z" Date: d—J permit is issued. f 3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY 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 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.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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 i ALTERNATIVE ENERGY PERMIT APPLICATION p ;- .. - .. �t wt r � "� p $ � brae t. � ;fit r f��.,.a\a..' A -. -. o_»....:u.cs f'iiE , �n..�.__..9, _,3._,r. ..�s...z.,,.a-:ir�:.:t41 „,U�.t��_nwti�l.�..).hu��9..ta-� 7'7-522,8, ' R 0 CUPERTINO 1 PROJECT ADDRESS drr APN# 2 2- OWNER NAME �;�t*i 1 i''1 1 1 ,t�Gt t t S�} PHONE � � E-MAIL STREET ADDRESS �� ' c i S l CITY,STATE,ZIP �t �pf �g�AX CONTACT NANIE Marjan Iavanmard PHONE650.477.6430 E-MA'mjavanmard@solarcity.com STREETADDRESS391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 FAX El OWNER ElOWNER-BUILDER El OWNER AGENT ❑ CONTRACTOR R CONTRACTOR AGENT IJl ARCH[TECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMESolarCity Corporation LICENSENUMBER88810rt LIC'ENSEMEC10 BUS.L`28840 COMPANY 1ESolarCity Corporation E-MAILmjavanm`card@solarcity.com FAX STREETADDRESS391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 PHONH650.477.6430 ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 9 COMPANY NAVE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ COmmerCial URBAN INTERFACE AREA ❑ Yes ❑ No. FLOOD ZONE ❑ Yes ❑ NO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: t 3 KILOWATTS(COMMERCIAL ONLY): ;J TOTAL VALUATION DESCRIPTION OF WORK Installation rooftop flush mounted solar panel 3 kW RECIE VEDB J By my signature below,I certify to each of the following: I am the pr,erL-p'ner or authorized agent tc acton the properly ovine T have read this application and the information I have provided is correct, I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction I a t_1rorJz-Fpresentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Dater f t SUPPLEMEI4 L INFORMA'T'ION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ ExPR1 sS U c7 ❑ STANDARD >4 u T _Aj Ci_LAR_ ❑ MA70R _..:... __ __PY_App_ZDII.docrevised03/1gV.____. CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION .: ADDRESS: 10784 W. ESTATES DR DATE: 09/23/2015 REVIEWED BY: PHUONG APN: 369-22-032 BP#: Iso *VALUATION; 1$7,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: I Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES TYPE: WORK INSTALLATION 13 ROOFTOP FLUSH MOUNTED SOLAR PANELS 3.38KW SCOPE Alech, Plan C'Fre:ck Pl imb. Plan('hecr, Flcc-Plan Check ;Czech. Perniz fee: Plumb, A' rmit Fee: Elec. Perrniz fee: 0171CI'h9eeh. Insp. (they Plun2b Imps. Oiher°t>lec.liup. Li I-- Mech,Insp.fee: Plumb.hiw). fee: Lkc.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/U132 FEE QTY/FEE MISC ITEMS Plan Check Fee:. $0.00 = # Alternative Energy System Suppl.PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. Q OT p,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.£Jns'truch.on T n}: administrative Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 7rcnjE�t 1�?ot•t�inentatiern Fees: Building Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 IBTOTAI.S $1.91 $236.00 TOEfi` $237.91 izzz Revised: 07/02/2015