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15090188-CANCELLED al U- 11Y. RECEIVED April 21, 2016 APR 2 5 2016 Dear Sir or Madam: BY This letter is to inquire about cancelling the permit for the following customer: Saikat Saha 7495 Stanford Place Cupertino CA, 95014 Permit# 15090188 The customer has decided to cancel their solar project with SolarCity. We hereby request a refund of fees, If possible. Refund checks can be mailed directly to the following address: ATTN: Iona Vil alba SolarCity Las Vegas 6671 S. Las Vegas Blvd Ste. 300 Las Vegas, NV 89119-3290 If you have any questions or meed anything further, please let me know. Sincerely, Marjan Javanmard, Permit Coordinator VIAI (650)477-6430 111 miavanmar solarcitv.com c� �' to ria 0554 MY Un WA00, CA F41 2 Y(65Q) 881402 (81"0)WL-GITY F NOW)638 10 2SOLARCITYMM All a e_ 841"i t t� €cr f _. _ lu r,:t !? [ r. ,gat CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7495 STANFORD PL CONTRACTOR:SOLARCITY PERMIT NO: 15090188 OWNER'S NAME: SAIKAT SARA 3055 CLEARVIEW WAY DATE ISSUED:09/29/2015 OWfNEWS PHONE: 4088937703 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 JOB-DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ 0 LICENSED CONTRACTOR'S DECLARATION INSTALL ROOF MOUNTED SOLAR SYSTEM(12 - , _1 (` MODULES)(3.12 KW). License Class (=(0 p O Lic.# (Tg y Contractor a3�> 1teL't i Date 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: Sq.Ft Floor Area: Valuation:$7000 i. 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:35932046.00 Occupancy Type: 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 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 I 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 Date: upon the above mentioned property for inspection purposes. (We)agree to save Issued by: indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue ag'nst said City in consequence of the granting of this permit. Addition ly,tH applicant understands and will comply with RE-ROOFS: all non-point source regulatio ,per the Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is y installed without first obtaining an inspection,I agree to remove all new materials for Signature J .. Date inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION 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. 1,as owner of the property,or my employees with wages as their soleHAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for 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. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will t I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance. ith th-clCupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Co e,Sectifs 25505,25533,and 25534. performance of the work for which this permit is issued. j 2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner,,or-"t#rot zed kcg tt C. _ Section 3700 of the Labor Code,for the performance of the work for which this r r' �` �' Dater- permit is issued. 3. 1 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 I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If,after making this certificate of exemption,I 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 shalt be deemed Lender's Addres revoked. s CERTIFICATION ARCHITECT'S DECLARATION APPLICANT 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 AM CCtr�lrvl�lNli Y DEVELOPMENT UEFARTIVIENT•BUILDING lLGlNzDIVISION 110300 rORRE AVENUE'f,UPERTINO, CA 950 i4-3255 '11'777-1228'FAX<<:, �1 7771-3333•bu:Idi Ig( �u 2nInaor f f CUPERTIN Lr1 E9E9 9a� PROJECT ADDRESS 1'CLo's 2�0 1 APN# o OWNERNAME ��� B_ S a. (/ °k 3 L��J\� PHONF� gy E-MAIL STREET ADDRESS �1 ! 1, L NATY,-STATE r+mc,) C q 5 a B� FAX CONTACT 'Marjan �Javanmard �.-P��H•ONE650.477.6430 E-MAII.mjavanmard@solarcity.com STREET ADDRESS 391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 FAX ❑OWNER ❑ OR'NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR M CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME SolarCity Corporation LICENSE NUMBERS8810i1 LICENSE TYPE C10 BUS.LIC P28840 COMPANY NAME SolarCity Corporation E-NIAILmjavanmard@solarcityF'� UCJ•com STREETADDREss391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 PHONE 650.477-6430 ARCI-BTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE f USE OF SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN I STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes 1A No FLOOD ZONE ❑ Yes KNo ER/soLAR PANELS JO ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELSlUNITS: f KILOWATTS(COMMERCIAL ONLY): TOTAL f VALUATION- 0. DESCRIPTION OF WORK Installation ( ice) rooftop flush mounted solar panel ;( _& aakVW RECEIVED BY: By my signature below,I certify to each of the following: I ani the properrytowner 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 it e read t4eDescription of Work and verify it is accurate. I agree to comply with it applicable local ordinances and state laws relating to building construction. ja i ize'representatives of Cupertino to enter the above-identified property for i pection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTA-L INFORMATrON REQUIRED OFFICE USE ONLY OYER TRrCOUNTER ❑ E%PRESS El n STANDARD U Z ❑ LARGE c, ❑ MAJOR PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 7495 STANFORD PL DATE: 09/29/2015 REVIEWED BY: SEAN 101APN: BP#: *VALUATION: 1$7,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: SOLAR-RE WORK INSTALL ROOF MOUNTED SOLAR SYSTEM 12 MODULES 3.12 k SCOPE p ,Wech. Non C:(.-.'heck I'lz;,,r1>. Non£'hecr I`'ien Pharz Check Al"'ch. A`i> rut Fee: I'larrni>. Pe;-M;f Fee: Re.c. Permit Fee: C1r!er Heck Irrsn. CJtite Plumb h Trt:s;s. oiber/stet:.Ins"). ,t r/. - /1 ec.Ins/:?. !,'ee: t!t?c/z.Imp, Fee: 1 rnli. his"). i•�`��: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS(Fee Resolution 11-053 E(f. 7111131 FEE QTY/FEEMISC ITEMS Plan Check Fee: $0.00 C1 # Alternative Energy System Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $236,0701PxOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0,00 PME Permit Fee: $0.00 C:onati-tiction Tax: 7= ,16hninistrative 1,ee: E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure 0 Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg-Stds Commission Fee: IBCBSC $1.00 :r SITBTOTAL ' $1.911 $236.00 `v T©T1LFE $237.91 Revised: 07/02/2015