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15100083CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20202 RODRIGUES AVE CONTRACTOR: SOLARCITY PERMIT NO: 15100083 OWNER'S NAME: FUNG-YEE LEUNG S PHONE: 4088929884 LICENSED CONTRACTOR'S DECLARATION License Class CQ -(D) C. L0 Lic. # ( U (Q `1 Contractor j 9 (0.t (' t } l 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: 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 performance of the work for which this permit is issued. 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. 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 t City of Cupertino against liabilities, judgments, costs, and expenses which m acc against said City in consequence of the granting of this permit. Ad tion I , the applicant understands and will comply with all non -point source reg tis the Cupertino Municipal Code, Section 9.18. i Signature Date i 0 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, 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: 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 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. 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 1 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 3055 CLEARVIEW WAY I DATE ISSUED: 10/12/2015 SAN MATEO, CA 94402 1 PHONE NO: (650) 638-1028 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALLATION OF ROOF MOUNTED SOLAR (18 MODULES)(4.68 KW). Sq. Ft Floor Area: I Valuation: $10000 APN Number: 36932046.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D S FROM LAST CALLED INSP C ION. Issued by: L"b"E4 ! ' Date: 10161905. 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 Applicant: Date: 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.I2 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 complian7 with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety de, ions 25505, 25533, and 25534. r Owner oratt ` ag l Date 0 � / � zy 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 Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed ALTERNATIVE ENERGY PERMIT APPLICATION AE CUPERTINO PROTECT ADDRESS L!O`�� �� Kh.� i �� ���.. APN m �� OWNER NAME ��� t i✓� C C� P ONE E-MAIL STREET ADDRESS d2.C)�' �`,Z �o ti � �.e;L, .�1uc.. CITY, STATE ZIP FAX CONTACT NANIE Marian Javanmard PHONE 650.477.6430 E-MAIL mjavanmard@solarcity.com STREETADDR.ESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ COYTRACTOR 19 CONTRACTOR AGENT ❑ ARCMTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESoIarCity Corporation LICENSE NUMBER 888104 LIC ENSE TYPE C 10 BUS, LIC g28840 COMPANY NAMESoIarCity Corporation E-NIAILmjavanmard@solarcity.com FAX STREETADDREss391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477.6430 ARCHITECT/ENGfNEER NAME LICENSE NUMBER BUS, LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUJTURE: ❑ Commercial PROTECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER, FOR SOLAR PANELS: NUMBER OF PANELS/UMTS: , � KILOWATTS (CONIMERCIAL ONLY). Iq � �( TOTAL VALUATION Io O ao. o DESCRIPTION OF WORK Installation (A-) rooftop flush mounted solar panel (Li • i�� kW jEED:BY:: By my signature below, I certify to each of the following: I am th rope owner 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 ead th seription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I a e esentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Appl icanUAgent; Date: SUPPLEMENVer INFORMATION REQUIRED --' OFFICE USE ONLY �-----------T----- �— F E U ra w U a a ❑ OVER -TAE -COUNTER �– ❑ E\PRESS ❑ STANDARD ❑ LARGE ❑ MAJOR PVApp_2011.doc revised 03116111 CITY OF CUPERTINOFM_7 FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc ). These fees are hosed an the nreliminary information available and are nnly an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) ADDRESS: 20202 Rodriquez Ave DATE: 10/12/2015 REVIEWED BY: Sean APN: BP#: `VALUATION: Isio,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: (E) Reg. Q OT PENTAMATION SOLAR -RES PERMIT TYPE: WORK Installation of roof mounted solar 18 modules 4.68 kW). SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc ). These fees are hosed an the nreliminary information available and are nnly an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 1 # $236.00 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: (E) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 'c" <„ f itu tr r�ta.1 E 1 F.c�s Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.30 $236.00 T'flTAL FEE: $238.30 Revised: 10/01/2015 U Z Q Ci ri Qo WQ (-5C-4O � ©a- N zm W O m O QO m J m �� oQ LL 7) O • n Q w _INCi (JJ o z po s, z �� "CMZ r �d� wz c=n wwo �.�a Sew M J w O W w OQ O I -q M � Z. -:..0O OInd Mw O oz 0 W NON O.t15 WS ZOp 0 --Z QM O WO4 OO6�j . ZOO: q? J M O2 0New 4 q2 J Z ¢Qy V �. 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