B-2017-1435 / CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1435
10451 BAYWQOD DR CUPERTINO,CA 95014-2309(316 30 146) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: CHANG SU-YUN ET AL DATE ISSUED:08/28/2017
OWNER'S PHONE:510-376-8042 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10C46 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:
(N)16-PANEL ROOF MOUNTED PV SYSTEM(4.8 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
rformance of the work for which this permit is issued.
9,. 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:$7104.00
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 316 30 146
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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign e / /Z1.% Date 8/28/2017 Issued by:Jasmine Archbold
Date:08/28/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the BE-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 dog 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:8/28/2017
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 Worke'r'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
3. 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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Ow 3a 4. authorized agent: /
APPLICANT CERTIFICATION D• 8/28/2017
I certify that I have read this application'and state that the above information is CONSTRUCTION LENDING AGENCY
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 harrnless!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.
Signature Date 8/28/2017 Licensed
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
AE .
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 FAX(408)777-3333.building a(�,cupertino.orq
PROJECT ADDRESS 1 /^ q S l a 6 LJ AjP1 �1(a -e r l/� APN# — �' I r
OWNER NAME VL IV/g � j PHONE %ick.37-6 �� rCo-1 CS' a'c�Gut-0k,C'QVt,
STREETSt
OCD ( � ,n ` CITY,STA J� d"� p - FAX
CONTACT NAME Gerrrry Igtanloc V-C/ �rJ �"ONE 650-7✓59-8042 gigtanloc@solarcity.com
STREET ADDRESS 391, Foster City Blvd. CITY,STATE,ZIP Foster City,CA,94404 FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME So larCity Corp. LICENSENUMBER888104 LICENSE TYPEC10,C46 BUS.LIC#28844
cGMFANYNA'SolarCity Corp. E-MAIL gigtanloc@solarcity.com FAX
STREET ADDRESS 3055 Clearview Way CITY,STATE,ZIP San Mateo, CA 94402 PH NE650-759-8042•
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL $ FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF RrStj or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes 1:1No FLOOD ZONE 0 Yes ❑ No
ElLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: /' KILOWATTS(COMMERCIAL ONLY): tztts eg TOTAL VALUAT" t;�jl
e-: 1
DESCRIPTION OF WORK
Install ( 6 ) rooftop mounted solar panels,( 4. ) KW
E DBY t
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 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 uilding .ns ction. I authorize representatives of Cupertino to enter the above-i entifiedproperty for inspection purposes.
Signature of Applicant/Agent /IAA. Date: D' f 2 7- h.7
SUPPLE ir NTAL INFORMATION REQUIRED
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PVApp 2011.doc revised 03/16/11
DocuSign Envelope 16:9315E206-7FA6-45AC-9C3F-068C3F630BBA o
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i / SMOKE I CARBON MONOXIDE ALARMS
f5` OWNER CERTIFICATE OF COMPLIANCE 411%
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
l —
CUPERTINO .10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buitdinct cupertino.orq
Permit leo.13) k 1 —(1F
Address 10451 Baywood Drive Cupertino, CA 95014 47tifAlarms tSrrauk 8 Carrtaonsl loi oxzu - 0
.::. C OT,BE:g ALFD. ND CO.100TEI).UNTIL THIS•CERRTIFICATE
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PURPOSE ..
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420:6 and 907.2.11.2 where no interior access for
inspections are required:
GENERAL INFORMATION
Existing single-family atd multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside fof each separate sleeping area in the immediate vicinity-of the X X
beddroonn(s)
On eve level of a dweilin unit includin;basements X X
Within each sleeping:room X
Carbon Monoxide'alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached`garage. Carbon monoxide alarms combined with smoke alarms shall comply with
,CBC Section°420.6 and shall be approved by the Office of the State Fire Marshal.
I f
Power Supply:In dwelling;units with no commercial power supply,alarm(s)may be solely battery operated.,:
'in existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do,
not result irCthe.removal,of wall and ceiling finishes or there is no access by means of attic,basement or crawl
'space.,Refer to CRC''Sectiori R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
'alarms which must he cannected to the building wiring.
i
As owner of'the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's:instructions and in compliance with the California Building
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have mad and agree to complywith the terms and conditions of this statement
Owner(or Owner Agents)Name: DocuSigned by:
Serena Chang striat�r ....s2 ' '"""' pM&;9/27/2017
Contractor''Name: I 4ADD3AF495C843E...
Signature tic.#..............................,_.....Date: ...................
Smoke and COform.doc revised 03118/14