B-2017-0579CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0579
1100 NOVEMBER DR CUPERTINO, CA 950144130 (362 17 022)
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: SINGH ANAND K TRUSTEE & ET AL
DATE ISSUED: 04/14/2017
OWNER'S PHONE:
PHONE NO: (650) 963-5100
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ROOFING Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
X BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL 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:
(N) 15 PANEL ROOF MOUNTED PV SYSTEM (4.725 KV)
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self -insure for Worker's
REVISION #1: ELECTRICAL PANEL UPGRADE (125 AMP); CHANGE
Compensation, as provided for by Section 3700 of the Labor Code, for the
MANUFACTURER OF MODULES (SAME #); INCREASE TO (4.875
performance of the work for which this permit is issued.
KW). ISSUED 7.7.17
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
Sq. Ft Floor Area:
Valuation: $8000.00
permit is issued.
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
362 17 022
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 regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
/1
ll
Signature Date �( /'l�7'—
Issued by: SEAN HATCH
OWNER -BUILDER DECLARATION
Date: 04/14/2017
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
inspecti�
sale (Sec.7044, Business & Professions Code)
Q
w�
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 11--7/ )
1--7/>
7`
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. 1 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.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date:
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-nev-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature j "� --- Date �� 7—
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(cDcupertino.orcl
C/d(0 k)o V&Xfjt,�
AE
PROJECT ADDRESS / _ j
T
APN #
/
OWNER NAME A - 6 a �� A / A. --/L
PHONE
E-MAIL
STREET ADDRESS / / `^ O / o � } -,4 ' 6 Aqt
[ t5/ /�/ V G Y'-'� R/
CITY T �E, !' N j� FAX
�N /T v, J
CONTACT NAME PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BUHMER ❑ OWNER AGENT ❑ CONTRACTOR. ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENrINIEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME en �n� jy& LICENSE NUMBER
YGCG. u �
LICENSE TYPE
BUS. LIC #
COMPANY NAME gv/A,n `G;
/�
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIPHOE,,
ARCHITECT,ENGINEER NAME
LICENSE NUMBER
BUS. LIIICCC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF in SFD or Duplex ❑ Multi -Family
STRUCTURE: 6 Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes
No
PROJECT IN
FLOOD ZONE Yes ❑ No
❑ SOLAR. PANELS
1 ❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
DESCRIPTION OF WORK
IN �v�J LS-fi• w( A V (C t
r4 A► v-) G %1 G u i i
2 k&r/L-,
P�BCEI\-ED BY
By my signature below, I certify to each of the following: I am the property ower or authorized agent to act on the property owner's behalf. I have read this
application and the information I have rovide sect. 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 Ing onstruction. I authorize representatives of Cupertino to enter the above -id ntified ope for inspection purposes.
Signature of Applicant/Agent: Date:
S PPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OYER -THE -COUNTER
❑ EXPRESS
v
❑ STA!NDARD
z
❑ LARGE
❑ MAJOR
PVApp_2011.doc revised 03/16111
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0579
1100 NOVEMBER DR CUPERTINO, CA 95014-4130 (362 17 022) SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: SINGH ANAND K TRUSTEE & ETAL
OWNER'S PHONE: 408-887-9782
LICENSED CONTRACTOR'S DECLARATION
License Class CLQ Lic. #888104
Contractor SOLARCITYCORPORATION Date 12/31/2018
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.
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
�j Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 regula jQns per the Cupertino Municipal Code, Section 9.18.
Date 4 1. 4.17
DATE ISSUED: 04/14/2017
PHONE NO: (650) 963-5100
BUILDING PERMIT INFO:
X BLDG _ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) 15 PANEL ROOF MOUNTED PV SYSTEM (4.725 KW)
Sq. Ft Floor Area: lValuation, $8000.00
"N Number: Occupancy Type:
362 17 022
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: SEAN HATCH
Date: 04/14/2017
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)
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: 4 L4 L7
I 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
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 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 G
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 4,14.12
11 A 11
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & SafetyCode, tion 25505, 2 33, and 25534.
Owner or authorized agent:
Date: 4.14.17
N TR TI E
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
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
90300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 ® FAX (408) 777-3333 - buildinc ino.or _
^
PROJECT ADDRESS l O U 6 ci^!e &2—
APN # d ^7— j
I (®ir!J
OWNER NAME l W �L VR
PHONF� -O
E
t A)`t e'f Cq
STREET 1 DRESS �0ayL
CITY, STMT•(, ZIP � � � � �
FAX
CONTACT NAME
Gerry Igtanloc
PHONE 650-759-8642
E-�I-gigtanioc@solarcity.com
sTREETADDREss391 Foster City Blvd.
CITY, STATE, ZIP Foster City,CA,94404
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT N CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMESOIarCity Corp.
LICENSENUMBER888104
LICENSETYPEC10,C46
BUS.LIC#28844
COMPANYNAMESOIarCity Corp.
EMAIL giCvg7ttlavnloc@solarcity.com
FAx
STREETADDRESS3055 Clearview Way
CITY, STATE, ZIP San Mateo, CA 94402
2110NE650-759-8042
ARCHITECT(ENGINEER 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
0"L PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
TOSOLAR WATER HEATING
❑ OTHER
FOR SOLARPANEL4: NUMBER OF PANELS/UNITS: 1 S' KILOWATTS (COMMERCLIL ONLY): L1 ZS
TOTAL VALUATION:
DESCRIPTION OF WORK
Install( j6 )rooftop mounted solar panels,( f, ZS) KW
RECE Y:
By my signature below, I certify to each of the following; I am the property owner or authorized agent to act on the DebDertv 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 building co ctio . I authorize representatives of Cupertino to enter the above-identififd property for inspection purposes.
Signature of Applicant/Agent: Date: l—{ 11 Z (1
SUPPLEMENTAL INFORMATION REQUIRED
;OFFICE USE ONLY
W OVER-TH COUNTER
0 EXPRESS ,-
U
❑ STANDARD
U
aLARGE
w
-
❑ MAJOR
PVApp 2011.doc revised 03/16/11
CC3v�'�