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B-2017-0206CITY OF CUPERTINO BUILDING PERMIT I BUH,DINGADDRESS: 22000 MCCLELLAN RD CUPERTINO, CA 95014-4060 (356 08 051) OWNER'S NAME: NITE ARNOLFO N AND ARLENE D OWNER'S PHONE: 408-691-1375 LICENSED CONTRACTOR'S DECLARATION License Class C-10: C-46 Lic. #888104 Contractor SOLARCITY CORPORATION Date 12/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing 3tb Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Ihave 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. APPLICANT CERTIFICATION 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulatio s peIrthe Cupertino Municipal Code, Section 9.18. Signature Date 2/2/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). [ hereby affirm under penalty of perjury one of the following three declarations: 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. 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. s. I certify that in the performance of the work for which this permit is issued, I sball 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code,•Section 9.18. Signature Date 2/2/2017 CONTRACTOR: i PERMIT NO: B-2017-0206 SOLARCITY CORPORATION SAN MATEO, CA 94402 DATE ISSUED: 02/02/2017 I PHONE NO: (650) 963-5100 BUILDING PERMIT INFO: BLDG —ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL JOB DESCRIPTION: N 24 -PANEL ROOF MOUNTED PV SYSTEM (6.24 KW) Sq. Ft Floor Area: ' I Valuation: $12000.00 "N Number: Occupancy Type: 356 08 051 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1'80 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby A ev nde Date: 02/02/2017 RE -ROOFS: 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. Signature of Applicant: Date: 01 ALL ROOF COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupergho Municipal Code, Chapter 9.12 and the Health & Safety Code, S .4tions 2 5125533, andd25534. Owner or authorized agent: - U Date: 2/2/2017 CONSTRU TION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building a0cupertino.org 1� - 2.n PROJECT ADDRESS APN II �Q I OWNER NAME PHONE 9 -13 E-MAIL((�� r —,r—& l_ 1Z �+ 1 G STREET ADDRESS CO Y, STATE, ZIP n OA FAX ""'Gerry Igtanloc PHONE650-759-8042 I E-MAILgigtanloc@solarcity.com STREETADDRESS391 Foster City Blvd. CITY, STATE, ZIP Foster City,CA,944041 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMESolarCity Corp. LICENSE NUNMER88810 t LICENSE TYPE BUS. LIC # 28844 COMPANY NAMESOIarCity Corp. t+C10,C46 EMAILgigta7nlo�c@sol�arcity.com FAX STREETADDRESS3055 Clearview Way CITY, STATE, ZIP San Mateo, CA 94402 J 1 v' '1650-759-8042 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 STRUCTURE: ❑ Commercial PROJECT IN WILDLAND i URBAN INTERFACE AREA ❑ Yes ❑ NO {. PROJECT IN FLOOD ZONE ❑ Yes ❑ NO SOLAR PANELS ❑ELECTRIC VEHICLE CHARGING STATION ElSOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): L- j TOTAL VALUATION: F� ` 4 VCJ DESCRIPTION OF WORK Install ( 2..sf rooftop mounted solar panels,((., ) KW BY: 9hAtv By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 build' construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: / �_% SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE orlJ w ❑ OVER-THE-COUNTER ❑ EXPRESS . U x ❑ STANDARD - U a❑ LARGE a ❑ MAJOR PVApp_2011.doe revised 03/16/11