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B-2016-3111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3111 10129 CAMINO VISTA DR CUPERTINO,CA 95014-2607(342 14 081) SOLARCITY CORPORATION SAN MATEO,CA 94402 OWNER'S NAME: TANG HUA AND NIU LIN DATE ISSUED:11/14/2016 OWNER'S PHONE:408-887-3046 PHONE NO:(650)963-5100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO License Class C10.C-46 Lie.#888104 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; (N)19-PANEL ROOF MOUNTED PV SYSTEM(4.94) Ielserg'-v 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 y � performance of the work for which this permit is issued. / :3 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: Valuation:$8000.00 '•. 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 342 14 081 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 againstsaidCityn in stands andce othe comply hg this WITHIN 180'DAYS OF PERMIT ISSUANCE OR Additionally,the applicantunderstandsand will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 11/14/2016 Issued by:Kim Dunbar Date: 11/14/2016 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 roofmg 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:11/14/2016 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 3. I 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 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,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. r Owner or authorized agent: APPLICANT CERTIFICATION ' Date:11/14/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING 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 ARCIUT CT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 11/14/2016 Professional .� / ALTERNATIVE ENERGY PERMIT APPLICATION • COMMUNITY DEVELOPMENT DEPARTMENT••BUILDING DIVISION 44L E 4.,0,9,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333 buildinq(ccupertino.orq / / i PROJECT ADDRESS 1 01 i 2 0.4<k it.t A u i c("(/4 �Eafj 1 L 6 i OWNER NAME i� / ® e PHONE if®) -"- <S _4EM C4'q cs b x)- 5_1----- STREET STREET ADDRESS/ / 1L, C/b-K amo Vc ACITY,ST`Et? 040,271 bio (I' woite FAX CONTACT NAME Gerry Igtanloc PHONE 650-759-8042 E-mmLgigtanloc@solarcity.com STREET ADDRESS 39.1 Foster City Blvd. CITY,STATE,ZIP Foster City,CA,94404 FAX OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0. CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER. 0 TENANT CONTRACTOR NAME So l a rC i ty Corp. LICENSE NUMBER 888104 8 81.0 A - LICENSE TYPE C 10,C46 BUS LIC 428844 2 8 8 A 4 COMPANYNAMESolarCity Corp. E-MAIL gigtaCJnlo`c@solarcity.Cio-rn FAX C,U`+ 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 In SFD Or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes 0 No FLOODzoNE 0 Yes. 0 No SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ❑ OTHER:. FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: `9 KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:,/) ' 25 F DESCRIPTION OF WORK Install ( tel ) rooftop mounted solar panels,(r. army.) KW 0;r,.%, r , r,, /, .""r�r//lli// rr/rf'/f//'�S f/Fmrr//r//rf / L'::::,;1/74! r ,F/ r,'r Jr rflf rr�fir 0rrrir/r f�; ,_ %r,�lr/fir it/rfi/n/l�J11 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 relatingtoalding construction. I authorize representatives of Cupertino to enter the above-ide tified prop rty for inspection purposes. Signature of Applicant/Agent: Date: 1,1. •4 ( 'c SUPPLEMENTAL INFORMATION REQUIRED #Z / 1�FtY ;Z',./MI 70 rlirT it r:/r If /r f1 r,sr rP/r1J'/firr'/l/frif%,lJ,r+�/,;'%f�l/r�1{rf 1 / ,74 r il'i S1S'elf/r fG..r''J`l',/`i%,1r i%' �i.l 1.0---1, / J i/s r 'fr�'ffrr fl` fA. l® �D-,'"t,./;r- *a/ r% � I"rr � �/r 4,1;,..4-0,f ,0 LARGE rr a'r/r'rf;'rr/J/r rsir�r ,",>P_,.:::,,-a`r r fi r":70 ll�ri'rriJJ wa// i/j r„ �x�� �rrr ��,r�" ter,,.,.,,,,.,, PVApp 2011.docrevised 03/16/11 ti ❑ ❑ I/ SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ss, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777..3333•buitdinq[ct�cutaertino.orq Permit No. a-'2-016 ^I ? Address 10129 Camino Vista Drive Cupertino, CA 95014 (#of Alarms(Saaoke & (Carbon Monoxide • IIiO :BEPiT E :AOEE iTS CERTIFICATE HIE PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2,112 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-familydwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit includinbasements X Y X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelling unitswith no commercial power supply,alarms)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in theremoval of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring, As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: (SI �natu�r 0171 � (sate:)d IHua Tang Contractor Name: Signature Licit Date: Smoke and COfarm.doc revised 03/I8114 ❑ � i •r e. \\\;�f WATER-CONSERVING PLUMBING FIXTURES 0 g J OWNER CERTIFICATE OF COMPLIANCE 7451,,:\- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C IJPERTI NO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333.buildinei(a cupertino.orq Owner Name Hua Tang Permit No. — Z®i - 3 1 ) Address 10129 Camino Vista Dr, Cupertino, CA 95014, US (SANTA CLARA County) PERMIT CANNOT BE FI11iALED AND COMPLETED UNTIL THIS CERTIFICATE . :::- Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? CI Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form Owner'Signature: Date: 0 No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner'Signature: Date: Cif No Go to Question 3. 3. Is water service permanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through 1101.8 do-not apply. Sign below and skip the rest of the form. Owner'Signature: Date:. Cr(No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? O No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner'Signature: Date: © Yes My real property is built and available for use or occupancy on or before January 1,1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. 0 My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures(regardless of whether property undergoes alterations or improvements). Cl My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whetherproperty undergoes alterations or improvements). ❑ Myproperty is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. SB4072014.doc revised 03118114