B-2017-1683 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1683
7407 TIPTOE LN CUPERTINO,CA 95014-5818(359 28 001) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: PATEL PARVEEN K AND NARAYANAN DIVYA DATE ISSUED:09/28/2017
OWNER'S PHONE:425-301-4058 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10.C46 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)14-PANEL ROOF MOUNTED PV SYSTEM(4.55 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
;�' t 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 359 28 001
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.•-r th�fMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.,
S4}i:ture rr\ >i1MM111�1� Date 9/28/2017 Issued by:Jasmine Archbold
4 _ii Date:09/28/2017
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,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/28/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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,Secti s 2 05 34.
Labor Code,I must forthwith comply with such provisions or this permit shall
I be deemed revoked. oi1�
s'iy�. 9 V l� !)\
Own-, uthorized a ent: i�s.
•
APPLICANT CERTIFICATION D. 9/28/2017 �� I
I certify that I have read thiss:application and state that the above information is CONSTRUCTION LEND NG AGENCY
correct.I agree to comply with all city acid 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 9/28/2017 Professional
'\\ / ALTERNATIVE ENERGY PERMIT APPLICATION
/' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4,yi,,flf, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 AE
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(a�cupertino.orq
PROJECT ADDRESS .r`Q I p/d s ) APN#
Uil
OWNER NAME pA (5_6730 1 ! 7 PHONE�< J�6/ -6ea5'e E-MAIL ,`e L ��CiAeMC-.Qct
STREET ADDRESS 1 ` ,V 4 7(pTe� z_iti CITYEs �Ttpzi O FAX
CONTACT NAME Gerry Igtanlo'c PHONE `v{{650-759-8042 E-MAIL gigtanloc@tesla.com
STREET ADDRESS 391 Foster City Blvd. CITY,STATE,ZIP Foster City FAX
❑OWNER ❑ OWNER-BUILDER 0 OWNER AGENT IR CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER ❑ TENANT
CONTRACTOR NAME 'SolarCityCorp. ICENSE NUMBER 888104 LICENSE TYPE BUS.LIC#
p C10,C46,B
COMPANY NAME SolarCity Corp. E-MAIL gigtanloc@tesla.com FAX
I STREET ADDRESS 3055 Clearview Way - CITY,STATE,ZIP San Mateo, CA 94402 i PHONE 650-759-8042
.ARCHITECT/ENGINEER NAME' LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 113 SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA ❑ Yes Ili No FLOOD ZONE 0 Yes $] No
a SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER:
FOR'SOLARPANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: cI 06 0
DESCRIPTION OF WORK ; ,':Install( I I ) roof mounted solar panels. (4 s-5)KW. '
1
I ,
.i
RECEIVEGY:: c )vaiLL2&
/11
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope 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 c nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: C9 ( 2 '.- 1 ( - - '
' SUPPLEME TAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTER °,
g 0 EXPRESS
STANDARD.
UU�
C. or
LARGE.
:.0 MAJOR .. . .
PVApp 2011.doc revised 03/16/11