B-2016-2789 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2789
10339 MCKLINTOCK LN CUPERTINO,CA 95014-2677(342 15 045) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: PRICE GARY R ET AL DATE ISSUED:09/23/2016
OWNER'S PHONE:808-896-1404 PHONE NO:(650)963-5100
LICENSED ENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Szt4 Lic.#52M X BLDG X ELECT —PLUMB
Contractor SOLARCITY CORPORATION Date 12/31/2016 —
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)14-PANEL ROOF MOUNTED PV SYSTEM(3.71 KW),2 ARRAYS;
I hereby affirm under penalty of perjury one of the following two declarations: (I)SUB-PANEL(125 AMP)
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.
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
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 42 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 342 15 045
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 consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 9-23-2016 Issued by:Kim Dunbar
Date:09/23/2016
OWNER-BUIL DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF 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 ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9-23-2016
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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
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 material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality.Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec' ns 2550 ,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9-23-2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING GENCY
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 9-23-2016 Professional
LoALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building ancupertino.org
2,01
PROJECT ADDRESS y q ��G(L APN# -341 - /S-
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OWNERNAME I,,, `�
Zb(4` ( CJ P,`g,ivz' r�g-IG w C E-MAIL
STREET ADDRESS TYSTATEZIP .
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CONTACT NAME Gerry Igtanloc PHONE 650-759-8042 E-MAIL gigtanloc@solarcity.com
STREET ADDRESS 391 Foster City Blvd. CITY,STATE,ZIP Foster City FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT [ja CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME SolarCi CO LICENSE NUMBER 888104 LICENSE TYPE BUS.LIC#
ty C10 C46,B 2-zE61-Q4
COMPANY NAME SolarClty Corp. E-MAIL gigtanloc@solarcity.com FAX
STREET ADDRESS 3055 Clearview Way CITY,STATE,ZIP San Mateo, CA 94402 PHONE 650-759-8042
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 PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes N No FLOOD ZONE ❑ Yes Ki NO
`R SOLAR PANELS To ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: i
DESCRIPTION OF WORK Install( I q) roof mounted solar panels. (3.}t )KW. [ 11
u i i
01D
By my signature below,I certify to each of the following: I am the property 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 read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi onstruction. I authorize representatives of Cupertino to enter the above-identified prope for inspection purposes.
Signature of Applicant/Agent: Date:—
SUITLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W OVER-THE-COUNTER
' � � ❑ EXPRESS
� El STAND ARD
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❑ MAJOR
PVApp 201 Ldoe revised 03/16/11