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
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