13120005CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10645 FELTON WAY
CONTRACTOR: SOLARCITY
PERMIT NO: 13120005
OtVNER'S NAME: LING STEPHEN EN AND HEUNG APRIL
3055 CLEARVIEW WAY
DATE ISSUED: 12/0612013
OWNER'S PHONE: 4083328639
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ® COMMERCIAL
License Class 4 Lie. #_ i _
Contractor Date �2, % " {
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:
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
Sq. Ft Floor Area:
Valuation: $9000
performance of the work for which this permit is issued.'
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
APN Number: 35918019.00
Occupancy Type:
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 1$0 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
180 DAYS F ALLED 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
Date %
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,
RE -ROOFS:
Signature D
All roofs shall be inspected prior to any roofing material being installed. If a roof is
i
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 structure isnot intended or offered for sale (Sec.7044,
Business & Professions Code)
1, 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 5.95 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
Section 3700 of the Labor Cade; for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, and 25534.
a- / $
Owner or authorized agent: Date,
permit is issued.
I certify that in the performance of the workfor 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
CONSTRUCTION LENDING AGENCY
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 aboveinformation 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 APPLICATI011,
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinga-cupertino.org
00
PROJECT ADDRESS
APN # 0
OWNER NAME j I' j
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PHONE y y)
E-MAIL
STREET ADDRESS
CETY, STAT ,ZIP
CA 61 i
FAX
CONTACT NAME�y yea -------
PHONE( jC
E-MAIL y
STREET ADDRESSCITY,
Sq t a!
STATE. ZI
q
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMB -
LICENSE NUMBER Igg
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
"X
STREET ADORES s /^e i,
Y, STATE, Z'yIP,,� �j �p,,g�gQQ''�� �+
PHONE
ARCHITECTIENGINEER NAME
0
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX.
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF WTSFDOrDuplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
Pt1R StIIrIR PANEI S. NUMBER OF PANELS/UNITS: C # TCILOWATTS:\',\ fi V ,l
t tl
TOTAL VALUATION",
DESCRIPTION OF WORK
4
�t-
RECE
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 relat,'mg, buil 'ng canstru Ian. uthorize repr ati of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ' Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
W
❑ OVER-TIIE-COUNTER
a.
y.
to
EXPRESS
U'
STANDARD:
M:..Q,b1ASOTt_.
PVApp_2O12.doc revised 06120112
CITY OF CUPERTINO
1VVV V4ZTIIr A T409 — VJ-MU_,f1I11JG 111VISTOVI
10645 felton way
FEE
DATE: 12102/2013
REVIEWED BY: Mendez
LaiADDRESS:
APN:
BP#:
*VALUATION:
1$9,000
Alternative Energy System
IPHOTOVRES Photovoltaic System
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Du
USE: lex
PME Plan Check:
PENTAMATION SOLAR -RES
PERMIT TYPE: A
WORK
install solar pv system on
SCOPE
$0.00
Suppl. Insp. Feer Reg. 0 jo�hrs
I Afe<:L Plan Cher,,k
'Wee t. Penuit 1, re'.
I other "'deck 7ri,4p,
"A'fech,
Plumb, P104 Cheek
Phimb, Permil Fee, -
Ocher 111unib 77sp,
Elec, Plan Cheek
Ek"% Permi! Fee:
01her Elee. lnsj.�,.
fllumlb. Mq. F'e: Eler, Insp. Fee:
NOTE. This estimate does not !Houde fees aue to
v1sir1cf, elcv. Iff - e_= UIC uuoeta
FEE ITEMS (Tee Resolution I
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$229.001
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (E) Reg. 0 OTF6 —.o I
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 jo�hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
_$0.00
Construction
,4,bninisirative fi-ee:
0
0
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
711Mel DoctonenLinon Fees.,
Strong Motion Fee: IBSEISMCR
$0.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SU1l3T0T-AL$t
$1.901
$229.00;,�,,_
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