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B-2016-2349 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2349 10105 CRESCENT RD CUPERTINO,CA 95014-1063(326 16 067) SOLARCITY CORPORATION SAN MATEO,CA 94402 OWNER'S NAME: WANG GARY CHORNG-JYH AND JUDY YIN S DATE ISSUED:07/20/2016 OWNER'S PHONE:408-674-6799 PHONE NO:(650)963-5100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ROOFING Lie.#B88104 Contractor SOLARCITY CORPORATION Date 1.2/31/201-0 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: (N)21 PANELS ROOF MOUNTED PV SYSTEM(5.46kW) 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 performance of the work for which this permit is issued. _ Ci 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. Sq.Ft Floor Area: Valuation:$12000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 32616 067 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in corgsjequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understayyds r1will comply with all non-point source regulations per the Cupe,ifio u icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 07/20/2016 Issued by:MELISSA Date:07/20/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 11 1 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. HAZARDOUSMATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or def�ices which emit hazardous air contaminants as defined by the Bay Area Air Q,y alityManagement District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Mu Slcipal t de,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2555,25• ,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:�` f APPLICANT CERTIFICATION Date:07/20/2016 I certify that I have read this application and state that the above information is CONSTRUC;'TIg L ENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 07/20/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION i 4 COUVVI M1 e'Y DEVELOPMENT Df_-lPAI?Tt>fiil_NT.EII.Iil. mc— ^IVIS*N1 x 4 L rf'TF} a h1' E � i tom„ �r. Csat.},_ .(=�s;i��:7':IdO,t;A:75i� 432:su Ll d°I! i }4UPS,F`�s`'-3`2 � FAX R f''er i�e 7 -��3�=bui di__q@cupet�'tnao T3ZGf 4- Z '3 �9 PROJECT ADDRESS i 5 &e-S APN 9 OWNFRNAME (�Ok:�,- WCkPHONE b '` E-MAIL STREET ADDRESS @ p �� ,TY, STATE,ZIP FAX CONTACT NAME Marjan /barJ an Javanmard �y ® PHGNE650.477.6430 IMA'Lmjavanmard@solarcity.com STREET ADDRESS 391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 501 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMESolarCity Corporation LICENSENUMBER888104 LICENSE TYPE C10 BUS.LIC 42884. COMPANY 11SolarCity Corporation E-11L c@solarcity.com FAX GUUU�F"'� STREET ADDRESS 391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 PHONE650.477.6430 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k COMPANYNAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE i USE OF W SFD Or DLtpl,, ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA s❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO VOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING - ❑. OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: I KILOWATTS(COMMERCIAL ONLY). 5. TOTAL VALUATION: ow.0C DESCRIPTION OF WORK Installation L1 ) rooftop flush mounted solar panel (5-C4 6) kW By my signature below,I certify to each of the following: I am the p P4,tuner or authorized agent to act on the ro wner's behalf. I have read this application and the information I have provided is correct. I have r d t e' escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consfnict on orie epresentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 0 0 SUPPLEMENTAL INFORMATION REQUIRED /� `� OFFICEIiSEOI+fLY �p -: "f p Y'O vtl OVER-TFIE COUNTER .P/X t S s ❑ k�; r? � � EXPRESS U. STANDARD LARGE a ❑ NIAJOR PVApp_2011.doc revised 03/16/11