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B-2017-1597 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1597 10247 VISTA KNOLL BLVD CUPERTINO,CA 95014-1033(326 13 129) SOLARCITY CORPORATION SAN MATEO,CA•94402 OWNER'S NAME: HELVEY R CURTIS AND WANG EVA M C TRUSTEE DATE ISSUED:09/18/2017 • OWNER'S PHONE:408-736-0450 PHONE NO:(650)963-5100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 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)16-PANEL ROOF MOUNTED PV SYSTEM(5.2 KW) I hereby affirm under penalty of perjury one of the following two declarations: REV#1 UPGRADE PANEL(125 AMP)-ISSUED 10/10/2017 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 .erformance of the work for which this permit is issued. �1 1 .a 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:$10000.00 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 326 13 129 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 Cu.ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. rte. ature •��'!►�:/ ,L���` Date 10/10/2017 Issued by:Jasmine Archbold Date:09/18/2017 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) 2. I,as owner of the property,atmexclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10/10/2017 I hereby affirm under penalty of Perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 laws of California. If,after making this certificate of will maintain compliance with the Cu.ertino Municipal.Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ®; Ow�n�e " • thorized agent: APPLICANT CERTIFICATION f;te. r r 0 O, I certify that I have read this application and state that the above information is CONSTRUCT . • r ING AGENCY correct.I agree to comply with all city and county ordinances and state laws 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. Signature Date 10/10/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION - ;eft, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 s' (408)777-3228 • building@cupertino.org PEMIT#B- .2..On - A CUPERTINO REV II 20. DEF# El NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. CI MEP 111RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS .{ 7 Vi f v\of givA APNI OWNER NAME / c+ 4 �� PHONE 40? -7 3 L. h $MAIL V 4.......h��vey n y0,636• ,,,,, STREET ADDRESS fTvl \ y CITY, STATE,IXZIP S U Q, 9 /� ``�/ yr CON t11.,OR x r❑\ii o. l r 11 NB/" L��6NUMBER\ I CAICENS��1)� TYPE CNC Cr% i Ng 1 CH . STREET ADDR 1 lac wIV akb CI Y,STATE, ZIP . 1 ki\gX 1 \1' 'Y i_ CA `1`11.104 E-MAIL 1/ PHON BUS.LIC k tl Z C GS C,o�S' 6,Ae olo e i6gk(P(' 06E8 / 04 0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL irk, OAS (..WAk tai STREET ADDRESS CITY,STATE,ZIP PHONE , U t Gt, (na:,f\ C v ; (� ‘)0.t.il k- tzAvit. ...p </six/CR, ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES F TOTAL NET SF USE TYPE .00C SQ.FT. VALUATION($) • REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISTNG ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS El NO 0 NO ❑NO DWELLING SECOND DWELLING' D YES ❑ATTACHED❑DETACHED OTHER UNITS F UNIT ADDITON: : ❑NO S F POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF IjVED BY: n /TOTA VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools remlires Department of Environmental Heath approval } 0- A.• ,� , / 2.I ViQ\ RE-ROOF EXISTING ROOF TYKE: E BUILT-UP ROOF E ASPHALT SHINGLES I=1 WOOD SHAKES 1=1 WOOD SHINGLES E TILE OTHER(SPE IF ) im' REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ; ROOF CLASS D YES ;OF LAYERS THICKNESS❑5/8" OTHER ❑OSB 1=1CDX OTHER •12 A PROPOSED ROOF TYPE:EIBUILT4UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES D WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF Pof SQUARES 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for insp- ti., •u-.s.ses. I acknowledge and authorize all information contained on this application form to be made available for public record. P� I Signature of Applicant/Agent: �VIVL '. Date: \Z5 (10/17 . SUPPLEMENTAL INFORMATION REQUIRED I ' *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this1project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. • *HOA-Provide a letter of approval from the Home Owner's Association BldgApp_2017.doc revised 08/01/17 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1597 10247 VISTA KNOLL BLVD CUPERTINO,CA 95014-1033(326 13 129) SOLARCITY CORPORATION SAN MATEO,CA 94402 OWNER'S NAME: HELVEY R CURTIS AND WANG EVA M C TRUSTEE DATE ISSUED:09/18/2017 OWNER'S PHONE:408-736-0450 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) 16-PANEL ROOF MOUNTED PV SYSTEM(5.2 KW) I hereby affirm under penalty of perjury one of the following two declarations: 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 few ,Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000.00 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 326 13 129 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 pe-th- upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sig, ure ; 'FF Date 9/18/2017 Issued by:Jasmine Archbold 40 Date:09/18/2017 OWNER-BUILDER DECLARATION I hereby aftirm: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. ,fsale(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 1 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. 1 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, •ctio I:25505,25533 and 25534. Labor Code,I must.'forthwith comply with such provisions or this permit shall •''' /�,' J be deemed revoked:' Owner•:, uthorized agent: Irl` t APPLICANT CERTIFICATION Dat,E. ii:20 I certify that I have read this application and state that the above information is CONSTRUCTION LEN d ING 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 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 complywith 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 9/18/2017 Licensed Professional \\ I // ALTERNATIVE ENERGY PERMIT APPLICATION ©' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION AE 4:,-,-.19,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408),777-3333•building@cupertino.org g'—201,1^ -- 1611, PROJECT ADDRESS10 2.44 u l<74 (i 9d /�, - APN# 3'2- . . ' 3 J i 2-9 E-MAIL v4 OWNER NAME ,' 1 �v��� PC, -. ` 3b rO LeSo cup1-1- z) I ibttepda-JLL' STREET \1.,s _n,_�,_ITY, STATE,ZAP /� � foo ��y FAX FAX . CONTACT NAME Gerry Igtanloc , ��V PHONE /`�r6✓50�--+759-8042 E-MAIL Vgigtanloc@tesla.com STREET ADDRESS 391 Foster City Blvd. CITY,STATE, ZIP Foster City FAX ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT U1 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME SolarCity Corp. ICENSE NUMBER 808104 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 ' al SFD or Duplex El Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE ❑ Commercial' URBAN INTERFACE AREA El Yes III NO FLOOD ZONE 0 Yes Irl No at SOLAR PANELS ' 0 ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: « KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION a DESCRIPTION OF WORK ' Install ((b ) roof mounted solar panels. (5,)-)KW. ' RE EIVED B Bymysignature bel j �A� P ( : gn ow,I certify to each of the following: I am the property owner or authorized agent to act on the property owners behalL 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 n uildi construction. I authorize representatives of Cupertino to enter the above-idennt�tiifie prope for inspection purposes. Signature of Applicant/Agent: ` Date: D`"4 �I • , SUPPLEMENTAL INFORMATION REQUIRED ON r ,„O$FIGE USE ONLX ww `fl. OVER THE COUNTER ,,r+ r" ❑ EXPRESS,. a J.'', '`1j,STANDARD ;i a •la LARGE f , .0 MAJOR . ' PVApp 2011.doc revised 03/16/11