B-2016-2602CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2602
6776 CLIFFORD DR CUPERTINO, CA 95014-4571(369 27 015)
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: RAVIKRISHNAN SOUMYAAND JAGANNATHAN RAVI
l
DATE ISSUED: 08/29/2016
OWNER'S PHONE: 408-548-7284
PHONE NO: (650) 963-5100
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC-10 Lic. #$$B1044
Contractor SOLARCITY'CORPORATION Date 12/31/2016
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:
'
(1) 19-PANEL ROOF MOUNTED PV SYSTEM (4.94 KW)
I hereby affirm under enal of er'u one of the following two declarations:
y penaltyp l
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.
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.
Sq. Ft Floor Area:
Valuations $11000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
369 27 015
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 c f hequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant unders sands d will comply with all non-point
source regulations per the Cu ino u icipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/29/2015.
Issued by: Kim Dunbar
Date: 08/29/2016
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. 1, 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: 8/29/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF-COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS 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
a. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) 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 de es which emit hazardous
I
Worker's laws California. If, this
air contaminants as defined by the Bay Area Air Q�ty I agement District
`Eipal
Compensation of after making certificate of
exemption, I become subject to the Worker's ,Compensation provisions of the
will maintain compliance with the Cupertino Mu - o e, Chapter 9.12 and
the Health & Safety Code, Sections 25 51 5 , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. C�
r
"Owner or authorized. agent: -
APPLICANT CERTIFICATION
Date: 8/29/2016 /�
I certify that I have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and state laws
ON irt?TION LENDING AGENCY
��
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
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 8/29/2016
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingacupertinagg
m
PROJECT ADDRESSTIC or.
7AP N
OWNER NAME
V; j6(CACLV\1/k CkAk�-V,
PHONE
LIZ - 5Z4 8 7229 'A
E-MAIL
STREET ADDRESS C/ftot 0 1
A/ '501
FAX
CONTACT NAME
Javanmard
PHONE650.477.6430
E-MAILmjavanmard@solarcity.com
mjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 944041
FAx
11 OWNER 11 OWNER -BUILDER 171 OWNER AGENT 11 CONTRACTOR 9 CONTRACTOR AGENT 11 ARCHITECT El ENGINEER- 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Sol arCity Corporation
LICENSENUNIBER
888104
LICENSE TYPE C 10
Bus- Ll"28844
COMPANYNAME
SolarCity Corporation
E-MAIL City.COM
mjavan mard @solar
FAX
STREETADDREss391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PHONE 650.477.6430
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF dSFD or Duplex El Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: 0 Commercial
URBAN INTERFACE AREA El Yes F1 No
FLOOD ZONE 0 Yes El NO
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
El SOLAR WATER HEATING
El OTHER:
FOR SOLAR PANELS. NUMBER OF PANFLSIUNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
DESCRIPTION OF WORK
Installation I 1c, rooftop flush mounted solar panel (�j_qq) kW
LEO
fJ
EP�
By my signature below, I certify to each of the following: V,/m , p My owner or authorized agent to act the property owner's behalf. I have read this
�o e '
information -
application and the infoation I have provided is correct 4 have rx e Description of Work and verify it is curate. I agree to comply with all applicable local
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ordinances and state laws relating to building construe on. at h izere esentatives of Cupertino to enter the above-idontif, I property for Ospection purposes.
Signature of Applicant/Agent: Date: o? AA _L6_
I/
SUP TAL INFQRMATION P Fll[t list ONLY 4RED 7
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VER _COIJNTER,'_4�L%
Pr
STANDARD
El LARGE
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MAJOR
PVApp_,2011.doc revised 03116111