15120195-DPI CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 21337 METEOR DR I CONTRACTOR: SOLARCITY I PERMIT NO: 15120195 1
OWNER'S NAME: JAYDEEP RANADE.
S PHONE: 6198223874
LICENSED CONTRACTOR'S DECLARATION
�icense Class 0-1 O 0 - Lic. # gg t p q
contractor Z010Lre —i l 1 Date /�-3 t/ (5
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 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 the City of Cupertino against liabilities, judgments,
costs, and expenses which may acc a against said City in consequence of the
granting of this permit. Addition , th pplicant understands and will comply
with all non -point source regul ions p r e Cupertino Municipal Code, Section
k9.18. (r '' KK
gnature Date I v2—� V
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
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 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 ( DATE ISSUED: 12/23/2015
SAN MATEO, CA 94402 ! PHONE NO: (650) 638 -1028
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALL ROOF MOUNTED SOLAR (9 MODULES)(2.34 KW).
Sq. Ft Floor Area: I Valuation: $5000
APN Number: 32643005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: /_:5 re4 /Y A4% Date: /,:p -,V73 %5
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 9.12 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 contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino u ' ' al Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 2 3 d 25534.
Owner or authorized agent: Date: 1�
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
I
Lender's. Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21337 Meteor Dr
DATE: 12/23/2015
REVIEWED BY: Sean
APN:
BP #:
*VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Alternative Energy System
IPHOTOVRES Photovoltaic System
PENTAMATION SOLAR -RES
PERMIT TYPE.
WORK
Install roof mounted solar 9 modules 2.34 k
SCOPE
$0.00
:'vkc1t. penwi..1: ,
0111x;,° Plirruh hf ;Sp. ED
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 preliminary information available and are only an estimate. Contact the Deptfor addn'l tnLo.
FEE ITEMS (Fee Resolution 11 -053 E(L 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee:) Reg. C) OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,fSc?'d'd2iftis'!1'rkf..'c' ��'cre:
Q
G
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
0
i
7"Povel 17oi;umentatior F-1 —es
Strong Motion Fee: IBSEISMICR
$0.65
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS
$1.65
$236.00 TOTAL FEE
$237.65
Revised: 10/01'/2015
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(cDcupertino.org /
AE
PROJECT ADDRESS r7 i 3 2 :1- LoM
` D y9 .
APN # _ o' l�
�_ � �
OWNER NAME ck e-e-D .4�GJCls��
PHONE
O l
O l -
E -MAIL
STREET ADDRESS JW Y
X13 3 .i
STATE, JI I�nD' C._ J� 1L
FAX
CONTACT NAME Marjan Javanmard
PHONE650.477.6430
E- MAILmjavanmard @solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGENI ❑ CONTRACTOR IE1 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME SolarCity Corporation
LICENSE NUMBER 88810A
7-ENSE L ITYPE C10
BUS.LIC #28840
`F
COMPANY NAMESOIarCity Corporation
E -MAILn- ijavanmard @solarcity.com
FAX
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PHONE 650.477.6430
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi- Family
STRV" RE: El Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ff N' o
PROJECT IN
FLOOD ZONE ❑ Yes No
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOT V UATION:
DESCRIPTION OF WORK
Installation ( `( '[ ) rooftop flush mounted solar panel kW
RECEIVED BY: A /
By my signature below, I certify to each of the following: I am the pro �Isentatives 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 re iption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho ' e r of Cupertino to enter the above-identified
tl property for inspection purposes.
Signature of Applicant/Agent: Date: a, I �J r 15
SUPPLE MENTA FORMATION REQUI —
OFFICE USE ONLY
OVER - THE - COUNTER
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EXPRESS
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❑ STANDARD
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❑ LARGE
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❑ MAJOR
PVApp_201 Ldoc revised 03116111
SMOKE/ CARBON MONOXIDE ALARMS
OWNER. CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE.AVENUE • CUPER ""INO, CA 95014: -3255
CUPERTINO.
{408) 777 -3228 •.FAX {408.) 77Z -3333 buildinQCaD_cupertino.orca
Perinit' No:
rj
Address e? # of Alarms Smoke: `7 Carbon Monoxide:
i,
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE . j
HAS•.BEEN SIrNF,j�, AND RFTL1ItNED; TO THE BUILDING DIVISION
PURPOSE
- This affidavit is a self- certification for the installation of all require_ d Smoke and Carbon Monoxide. Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single- family-and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When 'the valuation of additions; alterations, or repairs to existing dwelling units exceeds '
$1000:00,. CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
'Monoxide Alarms be installed in -the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity.of the
bedroom(s) -
X
X
i
On. every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which- do not: contain: fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with .
CBC Section 420.6 and shall be' approved by the Office of the State Fire Marshal..
Power Supply: In dwelling units with no commercial power supply, alarm(s ) may be :solely battery. operated.
In existing dwelling units, alarms, are permitted to be solely battery operated where repairs or-alterations do
not result :in the removal of wall and ceiling finishes or there is no ,access by means of attic, basement or crawl
space. Refer to CRC Section.R314 and. CBC Sections .907.2..11.4. and 420.6.2. An. electrical permit is required for .
alarms which must be. connected to the building wiring.
As owner of the'above- referenced property, k hereby certify that the alarm(s) referenced above has/have been.
installed in accordance with the manufacturer's instructions and in: compliance with the California Building
and California Residential Codes:: The alarms have been test ed and are •operational, as of the date signed
below.
I have read -and aoree 'to comnly with the terms and conditions .of this sfatemen'f
Owner (or Owner Agent's) Name:
o2,1
1
Signature ..:............. ........................................................ ....:.:..:.:.:.:.....:.:....:. :... Date:- . O�' 6
Contractor Name:
Sinature ......................... ........................................... Licl ...................................... Date: ...
Smoke and CO form.doc revised 031,18114 .
CUPERTIINO
WATER- CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -32 o FAX (408) 777 -3333 • buildin4(o7cupertino.ord
Owner Namq �, 0 T� ot_v �-2L.� Permit "o
Address i� `� t 33� Cpl �b� E� �` LL),,p &\)C' K f R C( S-0 T
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
lk JeNo Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water - conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
Evv-
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non - compliant plumbing fixtures
to be replaced with water - conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non - compliant plumbing fixtures will be
replaced prior to date specified above with water - conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water - conserving plumbing fixtures comply with the requirements as indicated in the
table on the following mite. .
Owner or Owner Agent's Signature �" �._AIL� Daf&." I b I
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115