B-2017-1855 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1855
11650 REGNART CANYON DR CUPERTINO,CA 95014-4830(366 33 010) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: VENDROW ALEX AND STOLERMAN YULIA DATE ISSUED: 11/01/2017
OWNER'S PHONE:2 1:),-..11C9-.2.zevi PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class B.C10.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)31-PANEL ROOF MOUNTED PV SYSTEM-(10.075 KW)AND(N)
I hereby affirm under penalty of perjury one of the following two declarations: SUB-PANEL(125 AMPS).
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
111 Section 3700 of the Labor Code,for the performance of the work for which this 0
permit is issued. Sq.Ft Floor Area: Valuation:$5772.00
APPLICANT CERTIFICATION
I certify that I have read this application iand 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 366 33 010
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.
Tr r'„
;Sj�,ss ure G Date 11/1/2017 Issued by:Jasmine Archbold •
I VV Date: 11/01/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I ant 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:11/1/2017
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 CupertinoMunicipal 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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ anyperson 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,Ibecome subject to the Worker's Compensation provisions of the the #'Ith&Safety Code,Sections 25505,25533,and 25534.
Labor Code,•I must forthwith comply with such provisions or this permit shall -. 'n;
r - •-
be deemed revoked. ;A1 0��1 t4. thorized agent:i of/I
APPLICANT CERTIFICATION 4 Mar. 1/1/2017
I certify that I have read this application and state that the above information is CONSTRUCTION L7 DING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction fending 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.
1
Licensed
Signature Date 11/1/2017 ' Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
,,, 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
45r.t,..- (408)777-3228 • building@cupertino.org PEMIT#B- 2017 _ 4855
CUPERTINO REV# DEF#
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN II
11650.Regnart Canyon Dr .
OWNER NAME PHONE E-MAIL
Alex Vendrow 650.996.2289 avendrow@gmail.com
STREET ADDRESS CITY, STATE,ZIP
11650 Regnart Canyon Dr Cupertino,CA 95014
❑x CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME s LICENSE NUMBER LICENSE TYPE
Arwen Lott SolarCity DBA Tesla 888104 B,C10,C46 •
ISTREET ADDRESS CITY,STATE, ZIPI
391 Foster City Blvd Foster City,CA 94404 , ,
E-MAIL PHONE BUS.LIC it
arlott@tesla.com 951.331.0373 888104
I]ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER❑DEVELOPER❑TENANT
' CONTACT NAME E-MAIL
SAME AS CONTRACTOR
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
Install residential roof mount solar,31 panels,10.075kW .
®SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 8 TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN. REMODEL OTHR GARAGE ❑ATTACHED ,
BATHROOM SF SF SF SF El DETACHED
EXISING' 0 YES EICHLER ❑YES SECOND STORY ADDTITON ONO
FIRE SPRINKLERS 0 NO, ❑ NO
DWELLING SECOND DWELLING. 0 YES 0 ATTACHED❑DETACHED OTHER
UNITS q UNIT ADDITON: ❑NO S F
POOLSI ❑FIBERGLASS ❑'VINYL-LINED ❑GUNITE .0 PREFABRICATED
POOL-SF SPA-SFI SPA ATTACHED❑YES 0 NO I TOTAL-SF
RECEIVED BY: TOTAL VALUATION:
Commercial or Multi Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval JASMINE ARCHBOLD ' 5772
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF El ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NOI El ❑
IF NO PLYWOOD El 1/2" EI 3/8" PLYWOOD TYPE: I PITCH: - ROOF CLASS
❑YES #OF LAYERS THICKNESS5/8" OTHER OSB EICDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES El OTHER ' _
*Provide a signed copy of the Cupertino's Tear-Off Policy , SF I_ #oE SQUARES
By my signaturebelow 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 inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent:Agent:Amen Lott rA,°Ta.
Date:10.30.2017 '
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 this project.
*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