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14120078CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20820 MCCLELLAN RD
CONTRACTOR: SOLARCITY PERMIT NO: 14120078
OWNER'S NAME: LIN CHING-JUNGA
3055 CLEARVIEW WAY DATE ISSUED: 12/16/2014
OWNER'S PHONE: 4086665176
SAN MATEO, CA 94402 PHONE NO: (650) 638-1028
LICE SED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL E]
INSTALL 15 ROOF TOP, FLUSH MOUNTED PV PANELS (3.9
_
License Class L t!_ J �y� i q
KW)
�C
Contractor _ ' Date
I hereby affirm that m licensed unde provisions of Chapter 9
(commencing wi ection 7000) of Division 3 of the Business & Professions
Code and tha 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
Sq. Ft Floor Area:
Valuation: 58500
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
APN Number: 35920032.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that l have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
to building constructio and hereby authorize representatives of this city to enter
,
WITHIN Igo RMIT ISSUANCE OR
upon the above mentio ed property for inspection purposes. (We) agree to save
1 + CALLED INSPECTION.
indemnify and keep ha less th ity of Cupertino against liabilities, judgments,
"'--- -
costs, and expenses which ma a rue Inst said City in consequence of the
Z
granting of this permit. j Add i ally, t applicant understands and will comp
Issued Date: (7
with all non -point source reg';"'
e ations r the Cupertino Municipal Code, Section
9.18. r
i
RE -ROOFS:
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I lam exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reas(ons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 prop�rty, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (S'ec.7044, Business & Professions Code).
I have read the hazardous materials requirements wader Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm unde penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintai a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipme r devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Are lity Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupert' Mpal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25�255531;3nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
g
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply withiisueh provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
APPLICANT CERTIFICATION
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 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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit!. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATION �
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION _ n
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building�cupertino.org \�\\
PROJECT ADDRESS G Q v� �) v,'�/ l
` - C(e_ I
I a r' i P1,
I,
APN # S q Z0 —
OWNERNAME ✓lC.�'((_-C%C_ � � !t
PHONE ( cA, 1
G b 5 � i lv
E-MAIL
STREET ADDRESS ) 0 (' �( ,G y�.c C �l ( P, .
CITY, STATE, ZIP.FAX
CONTACT NAME nJw-+Irjan Javanmard
PHONE 650,477.6430
E-MAILmjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWN R-BUU- ER ❑ OWNER AGENT
❑ CONTRACTOR IN CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME QolarCity Corporation
LICENSE NUMBER 888104
LICENSE TYPE C 1 0
BUS. LIC #28840
CJCJ`f
COMPANY NAME SolarCity Corporation
E-MAIL mjavanmard@solarcity.com
FAX
STREET ADDRESS 39,1 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PHONE 650.477.6430
ARCHITECT/ENGINEERI,NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SPD Or Duplex ❑ Multi -Family
STRUCTURE: ❑ CbmmeIcial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
IZ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
FO SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: ` KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
DESCRIPTION OF WOR)
Installation (�) rooftop flush mounted solar panel O kW
By my signature below, I certify to each of the following: I am the perry owner or authorized agent to act on the pr_o_p_eave read this
application and the information I have provided is correct. I have r thcription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I auth rep sentatives of Cupertino to enter the above -id 9ptified property for inspection purposes.
Signature of Applicant/Agent: Date:
T
SUPPLEMENTAL
ORMATION rWIRED
OFFICE USE ONLY
W
❑ OVER-THE-COUNTER
a+
F"
x
❑ EXPRESS
U
x
U
a
❑ STANDARD
❑ LARGE
❑ MAJOR
PVApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
V M-7 �
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20820 MCCLELLAN DATE: 12/16/2014
REVIEWED BY: MELISSA
ApN: 359 20 032
BP#:
`VALUATION: $8,500
' PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: ISFD or Duplex
1 #
$236.00
PENTAMATION
PERMIT TYPE: SOLAR -RES
WORK
INSTALL 15 ROOF TOP FLUSH MOUNTED PV PANELS 3.9 k
SCOPE
hrs
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E" 7/1;1.3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC F�e: 0 Reg. 0 OTJ
0.0
hrs
$0.00
PME Plan C tk.
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
Q OT0.0
hrs
$0.00
PME Unit Foe:
$0.00
PME Permit', Fee:
$0.00
i
0
G
Work Withqut Permit? 0 Yes (j) No
$0.00
Advanced Planniiw Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Strow MotiI, on Fee:
IBSEISMICR
$1.11
Select an Administrative Item
Bldg Stds Cpmmission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.11
$236.00
TOTAL FEE:
$238.11
Revised: 10/01/2014
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