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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 I Ln ui , m uj U.> �cw � CL -I J e l 21 tnYy z. n V ~ O Q J o -p d Q Z 1 O � T'LLj UI ~ d uJ w.� q \ w w > Lo_ pd Lo LIj z � H T ) � z a - o m "vW Z u' .c d uN, tty m w W � _lam db H Q J Q Z y r' -j LIj 4 I U D QOM CO Z Z m z r m m�- Tp co 00 ZOO O U/) V/ d T. 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