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B-2017-0578CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0578 10561 CASTINE AVE CUPERTINO, CA 95014-1310 (326 44 034) SOLARCITY CORPORATION SAN MATEO, CA 94402 OWNER'S NAME: EKAMBARAM PORKODI AND SATRAWADA RAVI OWNER'S PHONE: 408-507-1072 LICENSED CONTRACTOR'S DECLARATION License Class _Q -M Lie. #888104 Contractor SOLARCITY CORPORATION 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. ISSUED: 04/14/2017 PHONE NO: (650) 963-5100 BUILDING PERMIT INFO: X BLDG X ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 9 - PANEL ROOF MOUNTED PV SYSTEM (2.655 KW); (N) SUB I hereby affirm under penalty of perjury one of the following two declarations: PANEL (200 AMP) 1. I have and will maintain a certificate of consent to self -insure for Worker's REV#1 - ADDING (6) PANELS (4.425 KW) ISSUED 5-11-20107 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. 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 ' s pe th Cupertino Municipal Code, Section 9.18. Signature Date 05/11/2017 OWNER -BUILDER. DECLARATION 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). Sq. Ft Floor Area: I Valuation: $7000.00 "N Number: Occupancy Type: 326 44 034 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 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 ofAppl Date: 05/11/2017 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. 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. 3. 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 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 05/11/2017 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 & Safety Code, Section 25505, 25533, and 25534. Owner or authorized agent: Date: 05/11/2017 CONSTRUCTION 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0578 10561 CASTINE AVE CUPERTINO, CA 95014-1310 (326 44 034) SOLARCITY CORPORATION SAN MATEO, CA 94402 OWNER'S NAME: EKAMBARAM PORKODI AND SATRAWADA RAVI DATE ISSUED: 04/14/2017 OWNER'S PHONE: 408-507-1072 PHONE NO: (650) 963-5100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-10 Lie. #888104 Contractor SOLARCITY CORPORATION Date 12/31/2018 X BLDG X 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: (I) 9 - PANEL ROOF MOUNTED PV SYSTEM (2.655 KW); (1) SUB I hereby affirm under penalty of perjury one of the following two declarations: PANEL (200 AMP) m. 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. 2Iphave 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: $7000.00 APPLICANT ANT RTIFI CATION 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 32644 034 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. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per t e C pertino Municipal Code, Section 9.18.. 180 DAYS FROM LAST CALLED INSPECTION. cl Z,Date: Signature 'Date 4.14.17 Issued by: SEAN HATCH 0 BUILDER DE 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: 4.14.17 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 ecti s 25 5, 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 G Date: 4.14.17 I certify that I have read this application and state that the above information is CONSTRUCTION L INGAGENCY 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. I understand my plans shall be used as public records. Licensed Signature Date 4.14.17 Professional ALTERNATIVE ENERGIE PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 6 (408) 777-3228 - FAX (408) 777-3333 - bLi.ildin-q@cuoerfina.org cuoerting.crg CUPERTINO _q 01 ® 0,0� PROTECT ADDRESS ' APN it „- Lt,c 4 — 6-3 OWNER NAME 1_ S A? r --A W IrO9) PHONE D i EMAIL u STREET ADDRESS CITY, STAT ZIP Asa J FAX CONTACT NAME Gerry Igtanloc PHGNE650-759-8042 E-MAILgigtanloc@solarcity.com STREETADDRESS 391 Foster City Blvd, CITY, STATE, ZIP Foster City,CA,94404 FAX 11 0 OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 8 CONTRACTOR ❑ CONTRACTOR AGENT ❑. ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESolarCity Corp. LICENSENUMBER888104 LICENSETYPEC10,C46 BUS. LIC428844 COMPANYNAMESolarCity Corp. E-MAILgigtanioc@solarcity.com PAx. STREET ADDRESS 3055 Clearview Way Crt'Y,STATE,ZIP San Mateo, CA 94402, 1101650-759-8042 ARCHITECT&NGINEERNAME LICENSE NUMBER BUS. LTC # COMPANYNAME E-MAIL FAX STREET ADDRESS' CITY, STATE, ZIP PHONE USE OF SFD or Duplex p Multi -Family STRUCTURE: ❑ Commercial PROJECT IN wILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION T SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UMTS: KILOWATTS (COMMERCIAL ONLY): L ^� 45 S TOTAL VALUATION: DESCRIPTION OF WORK Install( rooftop mounted solar panels,( Z ass } KW a4Yv cam, C 'L C) 14, D By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the properly owner's behalf. I have read this application and the information I have provided is correct. I have read t e Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to build' g cons ction. I auth representatives of Cupertino to enter the above -identified proye_rty ffir inspection purposes. Signature of Applicant/Agent: Date: L1 Its) S PLEMENT INFORMATION REQUIRED O FICE usE.or1LY - ❑-OVERTIIEE:xCO'UNTER„ �W - x a w EXPRESS ❑ STANDARD ❑ LARGE x ❑ MAJOR PVApp 2011.doc revised 03116111 1&L Z