B-2017-0136 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0136
10582 SANTA LUCIA RD CUPERTINO,CA 95014-3938(342 16 13 1) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'SNAME: PARRUCK BIDYUT AND SHOBHANAA TRUSTEE DATE ISSUED:01/25/2017
OWNER'S PHONE:408-728-8130 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10.C46 Lic.#888104
Contractor SOLARCITY CORPORATION Date 12/31/2018 X BLDG X ELECT _PLUMB
MECH X RESII)ENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — —
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(I)20 PANEL ROOF MOUNTED PV SYSTEM(6.3kW);(I)SUB
I hereby affirm under penalty of perjury one of the following two declarations: 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.
; J Jhave and will maintain Worker's Compensation Insurance,as provided for by
t Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$16000.00
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 34216 131
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 regulatio per a pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature/ Date 01/26/2017 Issued b LIOWNER-BUILDER DECLLTI --
Date:01/25/2017
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. 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)
z. 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:01/26/2017
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
s. 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,S to 2 05, 533,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:01/26/2017 U`
I certify that I have read this application and state that the above information is CNSTRUC ION LEND 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SiSignature Date 01/26/2017 Licensed
g Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.org
C3' ZO �34h
PROJECT ADDRESS 10,562, A-0%j—( ^ ` a-6 APN# ,� r
OWNER NAM �A� 4'b PHONE
(,(0 ?-X-6.S
STREET ADDRESSCITY STATE,ZIP PAX
S T Z. Z.G�G PY Q.Q Cott c7 L r4 -Kd l q
CONTACT NAME
Gerry Igtanloc PHONE650-759-8042 E-MAILgigtanloc@solarcity.com
STREET ADDRESS391 Foster City Blvd. CITY.STATE,ZTP Foster City,CA,94404 FAX
❑OWNER OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAMESolarCity Corp. LICENSENUMBER888104
LICENSE TYPEC10,C46 BUS.LIC#28844
COMPANY NAMESOIarCity Corp. EMAILgigtanloc@solarcity.com FAX
STREETADDRESS3055 Clearview Way CITY,STATE,ZIP San Mateo, CA 94402 P'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 ❑ NO FLOOD ZONE ❑ Yes ❑ NO
LAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/MTS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATrnra. '00
DESCRIPTION OF WORK
Install ( p ) rooftop mounted solar panels,( ` KW
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property Mner's be a 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 t with all applicable local
ordinances and state laws relating to bui 'ng construction. I authorize representatives of Cupertino to enter the above-identifle froperty fo nspection purposes.
Signature of Applicant/Agent: Date:
S PLEMENTAL INFORMATION REQUIRED
_OFFICE USE ONLY
W ❑- OVER-THE-COUNTER�
E" ❑ EXPRESS
x' ❑ STANDARD
V
a ❑ -LARGE
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❑ MAJOR
PYApp_201 Ldoc revised 03/16/11