B-2017-0468CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0468
10076 CRESCENT RD CUPERTINO, CA 95014-1012 (326 17 036)
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: WOO KENNETH AND MING-RONG C
DATE ISSUED: 03/23/2017
OWNER'S PHONE: 408-448-0140
PHONE NO: (650) 963-5100
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C10. C46 Lie. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
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) 31 -PANEL ROOF MOUNTED PV SYSTEM (9.765 KW)
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.
2,` , -1 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: $21000.00
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
"N Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 17 036
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 18O DAYS ANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulati pe the Cupertino Municipal Code, Section 9.18.
180 DAYS FR SPECTION.
Signature Date 03/23/2017
Issued by: MELISSAN
OWNER -BUILDER DECLARATION
Date: 03/23/2017
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. 1, 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: 03/23/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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. 1 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. 1 certify that in the performance of4he 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, tion 55 5 533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent: c, ,
APPLICANT CERTIFICATION
Date: 03/23/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LEND G AGENCY
I hereby affirm that there is a construction lending agency for the performance
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
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
AR DECLARATION
T
Code, Section 9.18.
used as public records.
I understand my plans shal1l1 bbe e u
Licensed
Signature Date 03/23/2017
Si 9
Professional
CUPERTIN.O
ALTERNATIVE ENERGIE PERMIT APPLICATION
COMMUNITY DEVELOPMENT' DEPARTMENT •'BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(4.08) 777-3228 - FAX (408) 777-3333 a buMiTa�@c1JpeTtno.ot'o,
k?A11--n q19
UA
PROJECT ADDRESS ® CQ 0
APN #
v `
OWNERNAME YV C�
PHONE
E -MAB:(/
STREET ADDRESS
CITY, STA E ZIP
C;A -7GC
FAX
.
CONTACT NAME Gerry Igtanloc
PHONE 650-759-8042
E-MAIL gigtanloc@solarcity.com
sTREETADD"-ss 391 Foster City Blvd. T-CrFY,
STATE, ZIP Foster City,CA,94404
FAX
I
❑ OWNER ❑ OWM-BU&DER ❑ OWNERAGENT ® CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMESolarCity Corp.
LICENSENUMBER88810/1
LICENSE' TYPEC10,G46
BUS. LIC 028844
COMPANY NA'SOIarCity Corp.
E-wLgigtanloc@solarcity.com
Fes`
STREET ADDRESS 3055 Clearview Way
CITY, STATE, ZIP San Mateo, CA 94402,
PHONE650-759-8042
ARCHTTECTIENGINEER NAME
LICENSE NUMBER
BUS_ LIC #
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE of SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
E SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑SOLAR WATER HEATING
El OTHER..
FOR SOLAR PANELS NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: 2, j �p
C d
DESCRIPTION OF WORK
Install ( 3, j) rooftop: mounted solar panels, (ej-&�) KW
RE D
'By my signature below, I certify to each of the. following: I'am the property owner or authorized agent to act on the roperty owner's behalf. I have read this
application and the information I have Ovid is correc I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
�entifi 4 property for inspection purposes.
ordinances and state laws relating to i in ns at, thorize representatives of Cupertino to enter the above -id
SignatureofApplicant/Agent: Date: � 2-
SUPPLEME AL INFORMATION REQUIRED
OFFICE usEotvix
W 0 OVER-THE-COUNTER
Uz
a.
a
'ExPRESS
❑ STANDARD
-
F1 LARGE "
❑MAJOR
PVApp 2011.doc revised 03/16/11