B-2017-0745 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0745
21513 CONRADIA CT CUPERTINO,CA 95014-4801(356 23 049) SOLARCITY
• CORPORATION
' SAN MATEO,CA 94402
OWNER'S NAME: VANDROVEC PETR ET AL DATE ISSUED:05/10/2017
OWNER'S PHONE:951-8623768 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 010 C46 Lic.#888104
Contractor SOLARCITY CORPORATION Date 12/31/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
(N)33-PANEL ROOF MOUNTED PV SYSTEM(10.725 KW);BATTERY
I hereby affirm under penalty of perjury one of the following two declarations: BACKUP(2);(N)SUB-PANEL(125 AMP)
:,, i. 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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$30000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 23 049
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 ST RTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUAN EOR
Additionally,the applicant understands,and will comply with all non-point
source regulatiys per e Cd.ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPEC ION.
� mi1'
Signet yJ '� Date 10-02-2017 Issued by:Kim Dunbar
' Date:05/10/2017
OWNER-BUILDER DECLARATION
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)
z. 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:10-02-2017
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. 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
a. 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, ctions'5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall I
be deemed revoked. Owner or authorized age of '11r4
APPLICANT CERTIFICATION
Date:10-02-2017
I certify that I have read this application and state that the above information is CONS CTION LENDING A ry NCY
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 gi.enting 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 10-02-2017 Professional
•
\���// ALTERNATIVE ENERGY PERMIT APPLICATION
/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONAE .
/yr,,g 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinA(G,cupertino.orq •
PROJECTADDRESS2(5 (C /L^RteciA cY APNB35 —176 k,4 al
,
OWNER NAME A! - nee_ PHONEJre)) a.b �4J�/ �EMA1L
•
STREET ADDRESS 2 103 /,,,® pA rJ j I, C; Crrrl :Tn_o r / Y 9.5...yl f)J PAX
CON ACT NAME Gerry Igtanlo'c" G GPHONE650-759-8(04.2 / E-MGAILgigtanIoc@solarcity.com
STREETADDRESS391 Foster City Blvd. . CITY,STATE,ZIP Foster City,CA,94404 FAX
I
❑,OWNER D OWNBR-BUILDER ❑ OWNER AGENT 0 CONTRACTOR ❑CONTRACTORMUNI' ❑ ARCHITECT ! 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTGRNAMB LICENSBNUMBBR LICENSE !BUS' •
SolarCity Corp. 8881 Q4 c�o,c4s , 28844 ' ', ..
COMPANY NAME PAX
SolarCity Corp. EMAIL gigtanloc@solarcity.com
STREET ADDRESS 3Q55 Clearview Way Com.STATE,ZIP San Mateo, CA 94402 'pH0NE 650-7598042'
ARCHITECr/ENGINEBR NAME LICENSE NUMBER ',BUS.LLC ft
COMPANY NAME E-MAIL $ FAX ,
STREET ADDRESS CITY,STATE,ZIP PHONE.
I,
use OF fl9SFD or;Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 1'❑ Commercial URBAN INTERFACE AREA ❑ Yes 0 No FLOOD ZONE ❑ Yes! 01 No
i
Ar
S
iOLAR PANBLS 0 ELECTRIC VEHICLE CHAROINO STATION , SOLAR WATER HEATING 0 OTHER: e
F(SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION /��ey
DESCRIPTION OF WORK
' ' Install (33 ) rooftop mounted solar panels,( 10,3? KW
'CO' AC- Paim -uo t I 1 CN) T2s"el w load ctok- t
W.,.19,0 :' : ' ,..':'..:2::: :;.:
By my signature below,11:.certilyy 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 information I have'pro'vi is co eet,.d 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 build' const tion. I authorize gr presentatives of Cupertino to enter the above-ide ltified pp a for inspection purposes.
Signature gent:.of Applicant/A .I x.. /..-�4-,4 Date: e5.7 JO; ' I
SUIRPLEMENTAL INFORMATION REQUIRED '. ;OFFICE USE ONLY
('� n�,( r W ❑;OVERTHLCOUNTER'
Y V ❑ EXPRE
SS
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MAJOR'• '
1 I
, PVApp 2011.4c revised 03/16/11
'I,
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0745
21513 CONRADIA CT CUPERTINO, CA 95014-4801 (356 23 049)
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: VANDROVEC PETR ET AL
DATE ISSUED: 05/10/2017
OWNER'S PHONE: 650-862-3768
PHONE NO: (650) 963-5100
LICENSED D ONT ACTOR' DECLARATION
BUILDING PERMIT INFO:
License Class CC-10:C-46-46 Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION:
(I) 33-PANEL ROOF MOUNTED PV SYSTEM (10.39 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
z. 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
Sq. Ft Floor Area:
Valuation: $30000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
35623 049
356
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulation r the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/10/2017
Issued by: Kim Dunbar
Date: 05/10/2017
OWNER-BUIL DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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: 05/10/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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
HAZARDOUS MATERIALS DISCLOSURE
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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, Sec ans 2550, 255 , and 34.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:—
CERTIFICATION
Date: 05/10/2017
APPLICANT
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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
ARCHITECT'DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
a
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 05/10/2017
Professional
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildlng(cDcupertino.ong
13?o(--�- 11 n--:� q5 -
PROJECT ADDRESS �1& �����
APN #
, /��
OWNER NAME ///� 1 Aye /� �'+VAC
I �r VVV A I _
PHONE�� E-MAIL
C✓ L. �J (i G
STREET ADDRESS ', / / �L, ` J n i1 / f
/L G
CITY, STA E IL . — t �J� yJ /
GPHONE650,-759-80x42 CMAILgigtanloc@solarcity.com
FAX
CONTACT NAME Gerry Igtanloc
E
STREET ADDRESS 391 Foster City Blvd.
CITY, STATE, "'Foster City,CA,944041
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME SolarCity Corp.
LICENSENUMBER888104
LICENSE TYPEC10,C46
BUS. LIC #28844
COMPANYNAMESolarCity Corp.
EMAIL gigtanloc@solarcity.com
FAX
STREETADDRESS3055 Clearview Way
CITY, STATE, ZIP San Mateo, CA 94402
PHONE650-759-8042
ARCMTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL f
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ��SFD or Duplex C] Multi -Family
STRUCTURE: CFD
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑Yes ❑ No
PROJECT IN
FLOOD ZONE ❑Yes El NO
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
r�
TOTAL VALUATIM, ` /n�q ;
'�s+Ld X11
DESCRIPTION OF WORK
Install ( ) rooftop mounted solar panels,( j 0.3 KW
Ou A-(, lerwA I` N r2 A rkit + ►-
REE Y:
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 information I have prove Is co have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
presentatives of Cupertino to enter the above-idetkified pr®pe for inspection purposes.
ordinances and state laws relating to build const tion. I authorize representatives
Signature of Applicant/Agent: ., �1.'t i`� `"' Date: 5/10
SUIVLEMENTAL INFORMATION REQUIRED
e -
OFFICE USE ONLY
❑ OVER-THE-COUNTER
W
�
U
a❑
a
❑ EXPRESS
❑ STANDARD
LARGE
❑ MAJOR
PVApp_2011.doe revised 03/16/11