B-2017-0671CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
22525 BALBOA RD CUPERTINO, CA 95014-5454 (342 18 040)
OWNER'S NAME: GANDHI DHRUMIL AND RENU TRUSTEE
OWNER'S PHONE: 408-204-6817
LICENSED CONTRACTOR'S F LA TI N
License Class 5 Lic. #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.
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
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
z! y
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 regulatio per the upertino Municipal Code, Section 9.18.
A
Signatur' Date 04/28/2017
CONTRACTOR: PERMIT NO: B-2017-0671
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
DATE ISSUED: 04/28/2017
PHONE NO: (650) 963-5100
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH X RESIDENTLAL _ COMMERCIAL
JO&DESCRIPTION:
INSTALL AC BATTERY STORAGE SYSTEM
Sq. Ft Floor Area: J Valuation: $7000.00
APN Number: Occupancy Type:
342 18 040
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 04/28/2017
hereby affirm that I am exempt from the Contractor's License Law for one of the M-RUM"N:
illowing 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 (Scc.7044,'Business & Professions Code). Date: 04/28/2017
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 -paint source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 04/28/2017
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: 04/28/2017
CONS CTIONY
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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org MISC
❑ PLUMBING ❑ MECHANICAL QELECTRICAI ❑
PROJECT ADDRESS 96A n �y _
MISCELLANEOUS
APN # 32"2—
2— v R r -
OWNER NAME an S tt
PHONE. � �(
E-MAIL 6
STREET ADDRESS _
CITY, STATE, ZIP /� 6���N ` 0 Vv Ind
u(X'1 550 If
FAX
CONTACT NAME Gerry Igtanloc
PHONE 650 -758 -8042E
-MAIL gigtanloc@solarcity.com
STREET ADDRESS 3055 Clearview Way
CITY, STATE, ZIP San Mateo, CA 94402
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME SolarCltyCorp.
LICENSENUMBER 8881041
LICENSE TYPE
C10 C46 B
BUS. LIC# 28844
COMPANY NAME SolarCity Corp.
E-MAIL gigtanloc@sloarcity.com
FAX
STREET ADDRESS 3055 Clearview Way
CITY, STATE, ZIP San Mateo, CA 94402
PHONE 650-759-8042
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF RI SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK C
TOTAL VALUATION:
RECEIVED
By my signature below, I certify to e ch 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 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 ildin cons uction. thorize representatives of Cupertino to enter the above -identified propeJrty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE:USE ONLY
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MEPM&App 201 Ldoc revised 06/21/11
SMOKE I CARBON MONOXIDE ALARMS
OWNER CER-fIF'CATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENTO0 4-32p5G DIVISION
10300 TORRE AVENUE • CUPERTIN
777-3333 • bull dingC�cupertino.or
777-3228 • FAX (408 )
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rk'YC.X�C" Y" - 1 R.L
for the installation of all required Smoke and Carbon Monoxide aor a o
rn
PURPOSE �907.2.11.2. where no interior access
This affidavit is a self-certi£icati°n
compliance with
2016 CRC Section 8314; 8315, 2016 CBC Sections 4_0.6 and
for inspections are required.
GENERAL INFORMATION
ti-famil d�velhngs shall be provided with Smoke Alarms ar'�Caun{S exceeds
and -multi y alterations, or repairs to existing b
Existing single-family and/or
Monoxide alarms. When the valuation of additions, d 420.6 require that Smoke Alarms
Sections 90-7.2-11.5
000.00, CRC Section 8314, R315, and CBl e follow ng locations
$1 CO ALARM
Carbon Monoxide Alarms be installed in SMOKE ALARM v -
ARBA X
ach se arate sleepvag area in the immediate vicinity of the I
Outside ofeach P X X
Smoke alarms shall not be located within 3 feet of bathroom door X
bedrooms) - (� t nit including basements and habitable attics
On every level of a hV611iN '
Within each slee incrroom appliances and that
s are not required in dwellings WI -13: h dolnocontain moke alarms comply with
Carbon Monoxide alarm 6 Carbon monoxide alarms comb
do not have an attached garage• by the Office of the State Fire Marshal.
CBC Section 420.6 and shall be approved s ma be solely battery operated.
units with no commercial power supply, alarmed Y
power Supply: In dw e g �tted to be solely battery operated where repairs or alterations do
Pow p is alarms are peTnu of attic, basement or crawl
In existing dtivelling units, electrical per
is required for
not result in th
e removal of wall and ceilirtg finishes 0� 11.4 and 420.6-2. Ane
space. Refer to CRC Section Reed to the bui dmSectg wi4: and C"Cring
alarms which must be connec s referenced above hasjhave been
ex I hereby certify that the alarm(s) California
As o
`�n-ier of the above -referenced prop ty is instn1-ctions and in compliance wlid a e operational, aslof the
installed in accordance i•�nth the s. The actL
' a Residential COdes. The alarms specified below have been testedal�
and Caliform Permit NN
date signed below. _
Address: -�` 2.5
Carbon Monoxide Detectors:
Specify Number of Alarms: _
r Smoke Alarms:
agree to comply with the Perms and onditions of this statement
I have read and
Date:
o ant's} Name: ........................
.. ........
Ovrner (or OVI`121
rd��t Si nature .................... ... � ,
C� Date.: ...................
Contractor Name:
Signature .............................
smoke and COform.doc revised 01/1ol=
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
/18)777-322 FAX (408) 777-3333 • L
adin cu ertino.or 9Zvd� �1
�✓ 1 ' 6 c�i'-Re it N o /� ® V
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1. Is your real property a registered historical site?
❑ Yes Civil Code Sections _1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
5✓7 No Go to Question 2.
2. Does your real property- have a licensed plumber certifying that, due to the age or configuration of the property or its
p1wibing, installation of water -conserving -plumbing fixtures is not technically feasible?
Yes. Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
❑ No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
—P -No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994:
Civil Code Sections 1101A through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form.
0/Yes My real property is, built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
Pse check ONE of the following:
IR My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced' with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a ncultifamily residential real'property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or unprovements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a conimercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the followim; pale.
Owner or Owner Agent's Signature: _ fi,',&A,, AM else .09 AA s' r y1^/ `� . Date: T/f�l�i7 I
Unnn con nletinu anrd si"inu thic C`.ertificate- nleace refijrn it to the Rnil(iinu l)ivicinn in nrcier to final vnnr hnildina n(-rmit
SB407 2015.doc revised 01105117