B-2017-1598 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1598
10040 ORANGE AVE CUPERTINO,CA(357 17 115) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: Vickie Peng • DATE ISSUED:09/18/2017
OWNER'S PHONE:408-893-3535 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:C-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:
(N) 15-PANEL ROOF MOUNTED PV SYSTEM(4.5 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.
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:$8000.00
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 357 17 115
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
sourceregula• s p-the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
m ture Date 9/18/2017 Issued by:Jasmine Archbold
4' Date:09/18/2017
OWNER-BUILDER D CLARATION
I hereby affirm that Lain 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)
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:9/18/2017
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
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 lawslof California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
e t
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sns 21.05,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, r or authorized agent:
APPLICANT CERTIFICATION 41.6 ate:9/18/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDINGGENCY
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 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.
Licensed
Signature Date 9/18/2017
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
41/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 AE
CUPERTINO (408)777-3228• FAX(408)777-3333•building a(�cupertino.orq
PROJECT ADDRESS 00 LI 0 ^G
APN#
OWNER NAME ,°
�
II PHONE E-MAIL
tl , 0q 2). 353 t(�� ff�zNt�t��. co F-(
STRFV C3 ( )v` irvi CITY, STATE,ZIP. w 150 (� FAX
CONTACT NAME Gerry Igtanloc ( PHONE 650-759-8[`0-/4/e2lL E-MAIL gigtanloc@tesla.com
STREET ADDRESS 391 Foster City Blvd. CITY,STATE, ZIP Foster City FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT I CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER, 0 DEVELOPER 0 TENANT
CONTRACTOR NAME SolarCity Corp. ICENSE NUMBER 888104 LICENSE TYPE BUS.LIC#
-- _ - y p C10,C46,B
COMPANY NAME SolarCity Corp. E-MAIL gigtanloc@tesla.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 IX SFD or Duplex ❑ Multi-Family PROJECT IN,WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA 0 Yes aNo ' `FLOOD ZONE 0 Yes ] No
SOLAR PANELS ❑, ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: i S KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
qt 00-2)
DESCRIPTION OF WORK Install ( �C ) roof mounted solar panels. (IS)KW.
•
r '
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 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 build. c ns A ction,I authorize representatives of Cupertino to enter the above-identif d property for inspection purposes.
Signature of Applicant/Agent: Date: D ct (l c II 1
SUPPLEMENTAL •TION REQUIRED '" O N
OFFICE USE ONLY
OVERTJIE;COUNTER:.
t is❑ EXPRESS
G7
!Ira STANDARD
Ci ,❑ LARGE
1 }r,`0 ,MAJOR
PVApp_2011.doc revised 03/16/11