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13110167CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10350 HENEY CREEK PL CONTRACTOR: SOLARCITY PERMIT NO: 13110167 OWNER'S NAME: CHOU SHINGSAN AND MUNMIE 3055 CLEARVIEW WAY DATE ISSUED: 1112512013 OWNER'S PHONE: 6509628163 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License ClassCtt Lic. # INSTALL 26 ROOFTOP PANELS, 6.5 KW Contractor Date I. hereby affirm that I am licen ed under the provisions of Chapter 9 (commencing with Section 7600) 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: 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. Sq. Ft Floor Area: Valuation: $26000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34248030.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 184 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 184 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued b tt Date: i -7_ ° t Y granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: be inspected to any roofing material being installed. If a roof is 9.18. ..- �' c -g e � Date i Signature Ali roofs shall prior installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the struuture is not intended or.offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have. read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this °`- - Owner or authorized agent: --Date: 1�kE permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18, Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE 'VENUE - CUPERTINO, CA 96014-3255 at: FAX .f; buildingacuperring.org PROJECP ADDRESS30 ` � APN # 2 t j 5. 'J WJE OWNER NAME pj `»hh il:. PHONE q y j 5 C { —v -MAIL STREET ADDRESS ( CITY, STATE, ZIP g q q FAX CONTACT NAMEo vk a PHONE t 0� E-MAIL r V—® } STREET ADDRESS CITY, STATE. ZIP �p FAX ❑ OWNER ❑ OWNER -BUILDER ® OWNER AGENT KSONTPACTOR ® CONTRACTOR AGENT ❑ ARCHITECT CI ENGINEER 0 DEVELOPER ❑ TENANT CONTRACTOR NAMB­ LICENSE NUMBER LICENSE TXPE BUS. LIC # COMPANY NAME E-MAIL JC STREET ADDRES /^ C Y, STATE, ZIP4N — - -_ PHONE BUS. LIC # ARCHITECT/ENGINEER NAME LICENSE NUMBER v COMPANY NAME E-MAIL FAX. STREET ADDRESS CITY, STATE, ZIP PHONE USE OF §tSFD or Duplex El Multi -Family STRUCTURE: © Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes NO PROJECT IN FLOOD ZONE © Ye5NO ILA SOLAR PANELS ® ELECTRIC VEHICLE CHARGING STATION SOLAR WATER HEATING ll OTHER: FOR S01 -4R PANEL S: NUMBER OF PANELS/UNITS:C # KILOWATTS: /" _ r 1�11(� (�J� TOTAL VALUATION: _ *I6 pyo DESCRIPTION OF WORK RECEIVED BY ; * ' By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf, I have read this application and the infonnation 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 t buil 'ng constru ion: uthorize repr ati of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: _ v Date: t— Z51 17s, SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-T11E-C6UNTER a I CJ. EXPRESS U w U D: STANDARD. �„ ; ❑ LARGE' a , Q; MASOR PVApp_20I2.doc revised 06120/12 FUS-Ewalwal 10 rva w LMV Plan ('Aieck Pbwlb. Nan ('heck Elec% Plan (,heck Pen tri Fee: plar'n b. Pem 1 Fee: ller?nii Fee: 0H -ter ,11 ch. )r p. LLJ Otlwr 11ho7b lrw?, I 01hep Elec. Insp, Lj A,fccb. Fe Phinih A,S!), Fee: Ele"'. Imp, Fee:R2LL1, JVOTE. This estimate does not include fees due to other Departments (ie. Flanningrumic wows, tire, aamrary aewerutstrict, achout ml, i Thorn foac are based nyl tho prolimifforp information availahle and are only an estimate Contact the Dept for addh I info. - ------------ FEE ITEMS (Fee Resolution 11-053 ET 711113) \,/1 .1 X N_,X, FEE ESTIMATOR - BUILDING DIVISION QTY/FEE, 21APN: ADDRESS: 10350 Heney Creek P1 DATE: 11/25/2013 REVIEWED BY: Sean Plan Check Fee: $0.00 I BP#: 7 *VALUATION: 1$26,000 j *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex $0.00 PENTAMATION SOLAR -RES I PERMIT TYPE: USE: WORK Installation of roof mounted solar system with (26) modules (6.5KW). Suppl. Insp. Fee -E) Reg. 0 OT 0,0 hrs $0.00 SCOPE Plan ('Aieck Pbwlb. Nan ('heck Elec% Plan (,heck Pen tri Fee: plar'n b. Pem 1 Fee: ller?nii Fee: 0H -ter ,11 ch. )r p. LLJ Otlwr 11ho7b lrw?, I 01hep Elec. Insp, Lj A,fccb. Fe Phinih A,S!), Fee: Ele"'. Imp, Fee:R2LL1, JVOTE. This estimate does not include fees due to other Departments (ie. Flanningrumic wows, tire, aamrary aewerutstrict, achout ml, i Thorn foac are based nyl tho prolimifforp information availahle and are only an estimate Contact the Dept for addh I info. - ------------ FEE ITEMS (Fee Resolution 11-053 ET 711113) FEE QTY/FEE, MISC ITEMS Plan Check Fee: $0.00 1 # $229.001 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: (j) Reg. 0 OT hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -E) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: bnini,.sarewhe,Fee: 0 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced PIgnning Fee. $0.00 Select a Non -Residential Building or Structure 0 A 0 Tra,,�el Doctimeritalion Fes; F Strong Motion Fee: IBSEISAffCR $2.60 Select an Administrative Item Bldg Stds..Commission Fee: I BCBSC $2.00 S TALL $4.60 $229.00 TOTAL FEX. Revised: 10/01/2013 CITY OF CUPERTINO r��uu rr,-Akll> — 'A1T11,-f1VV- -V1VIq1!fi)1J ADDRESS: 10350 Heney P1 DATE: 11/25/2013 REVIEWED BY: Sean APN: P BP#: *VALUATION: L26 _,600 7Creek *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair AN HECK TYPE. C PRIMARY SFD or Duplex S 0 1 x PENTAMATION SOLAR -RES PERMIT TYPE: USE: $0.00 PME Plan Check: WORK Installation of roof mounted solar system with (26) modules (6.5KW).. SCOPE $0.00 mb. Plan Check Eke, Rlan (.,he(,,k Xkch, Plan Check Ph I I I I � M6,A Permit F-4?e" phjmzbllermdr P'ee: Otho- r lumb /nsp, 0"he'r Ejec. Insp other,lfech, Heck I . nsp, Fee: Numb. hl-S'P, Fee", E'IecInsp. P'ec: NOTE. This estimate does not inctuctejees aue to ornermpanments ti -e. lanning, -u—I'm vrvI a, -9 rn"tart tho Dow far iyddnl info. "furict, c1c.'j.i sacae=- .. - V. FEE ITEMS LEee Resolution 11--0533 E. 711113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $229.00 Alternative Energy System Alternative RE PhotovoltaicSystem V S IPHOTOV ES Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeerReg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Feer $0.00 Consiructior Tax: F I Adininistrativefiee: 0 E) Work Without Permit? 0 Yes No $0.00— Advanced Planning —$0.00 Select a Non -Residential Building or Structure (F) 0 Trai;el Documentation Fees: Strong Motion Fee: IBSEISAffCR $2.60 Select an Administrative Item Stds Commission Fee: IBCBSC Badu$2.00 . $130TOTALS. $4.6C $233 Revised: 10/01/2013 UZ, z < -- moo ZE o Lo L 'CIO sl u Ilk 01 ;2 CL In 'u CL Lj >, LS Lu 8 "Ef h IL co uj U') LLJ < L ID ;Z Ln M Z 86 0 (a- LU MW go Ul) Lu W �-mYT 2 9 9 SIZ a-� SHP Z z d R F- Q< El ujSVi w w uj 05 LLI �Z<2 mm =2d no 06 C, w Ln C) S CJ o LU Ln 2 0 L.0 BE < oz- M� P= t2 g < -Oso M�-=n �2 4 s e� g Ln N N CL w CL �i O N N Q U U O Q w� O:nS Z O Z J 20 W c0 .- Z 4 J mOS ...., CL < W O W ~' C7 Y1 '`=tax x x KJ cU atn <M®aC ¢ 4 O g �g O W_ it [L O U— �W� ¢u S O < ® W M uj Z - zZo 0 o > Q V) &.3 W !? �Ln ®LJ � CL m � � u z m m 4!) a o m z a d d N � Ln W ' W O 2 � 4 � O > � w a �¢C in C 4-J o'`a Std BULL k AW n to ft® M O N O x H� J CL T J 'J LV W 0 F-- U ` Q ca En CL �j � � H 0 J V c a J Lt � LJ W Y- co 4 U Q CJ S W O (D Or co ��j a- b ZJ ® U Ln O M L a ' w Q is mi N gig A is 3 <`s�=< 9WHbU �4 y: LLI. t��tii•}} pf��Co �yrd�,�.a �i r�! 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