B-2017-1857 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1857 .
20861 DUNBAR DR CUPERTINO,CA 95014-1801(326 30 159) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: WANG WEI AND MAYONGFANG DATE ISSUED:11/14/2017
OWNER'S PHONE:248-703-3915 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
• License Class C10 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-(4.2 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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. •
�r7� 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:$5772.00
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 30 159
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.
Signature Date 11-14-2017 Issued by:Kim Dunbar
Date: 11/14/2017
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&'P.rofessions 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: 11-14-2017
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
performancepermitMATERIALS DISCLOSURE
of thewwork for which-[his is issued. HAZARDOUS
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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ;de,Sections 25505,25533,and-25534.
Labor Code,4 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized ager
APPLICANT CERTIFICATION Date:11-14-2017
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 bity'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 11-14-2017 Professional
r CONSTRUCTION PERMIT APPLICATION
(V
/ ;/ ;-i 4MUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
4:0.1.9.t,
(408) 777-3228 • building@cupertino.org PEMIT#B- 2017 _ 1857
CUPERTINO -. ' REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION El T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS - , APN#
20861 Dunbar at 326 30159
OWNER NAME PHONE E-MAIL
Haosheng Wang (248 703-3915 hwang48@dons.usfca.edu
STREET ADDRESS CITY,STATE,ZIP
20861 Dunbar Dr . Cupertino,CA 95014
❑. CONTRACTOR NAME 0 OWNERTBUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
Arwen Lott SolarCity DBA Tesla 888104 B,C10,C46
'ISTREET ADDRESS CITY,STATE,ZIP I
391 Foster City Blvd Foster City,CA 94404
E-MAIL PHONE BUS.LIC#
arlott@tesla.eom 951.331.0373 888104
El ARCHITECT ❑OWNER ❑OWNER AGENT El CONTRACTOR AGENT 0 ENGINEER El DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
SAME AS CONTRACTOR .
STREET ADDRESS CITY,STATE,ZIP PHONE '
DECRIPTON
Install residential roof mount solar,14 panels,4.2kW
❑x SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. ' VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED '
EFIRE SPRINKLERS 0 NO EICHLER 0 No SECOND STORY ADDITION 0YES
NO ,
DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS tt UNIT ADDITON: 0 NO S F
POOLS' 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED '
I
POOL-SF SPA-SF SPA ATTACHED❑YES ❑NO TOTAL-SF
RECEIVED BY: TOTAL VALUATION:
Commercial orMutti-Family Buildings with Public Swimming.Pools requires Department of Environmental Heath approval Jasmine Archbold 5772
RE-ROOF I EXISTING ROOF TYPE: ❑BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NOI IF NO PLYWOOD ❑1„ ❑3/5" PLYWOOD TYPE: PITCH: ROOF CLASS
El YES #OF LAYERS' THICKNESS❑5/8" OTHER ❑05B ElCDX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ['ASPHALT SHINGLES❑WOOD SHAKES['WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy , SF Sof 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 inspection purposes. I acknowledge and authorize all information contained,on this application form
to be made available for public record.
Signature of Applicant/Agent:Arwen Lon ; m.;:m=' Date:10.30.2017
SUPPLEMENTAL INFORMATION REQUIRED
*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
•
SoIrCfty
•
February 6,2017
RE: Permit Authorization
• Dear Sir or Madam: •
This letter is to verify that Gloria Bautista is an authorized representative of SolarCity Corporation and is
authorized to pull any and all permits, business licenses, and any other project related documents as
needed. Please don't hesitate to call if you have any questions.
•
Sincerely,
James Cahill •
SolarCity Corporation,RME •
650-963-5100
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
•
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document,to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document
State of CRI trurni
County of L3 Ori el*S , •
I
J
On l /J'O1 before me, Xemi 0. M Pei" n • , personally
appeared James Cahill ,who proved to me on the basis of satisfactory evidence to be the
person whose name is subscribed to the within instrument and acknowledged to me that he executed the
same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon
behalf of which the person acted, executed the instrument.
I.certify under penalty of perjury under the laws of the State of California that the foregoing
. paragraph is true and correct.
•
Witness my hand and official seal. XENIA MARICELA LARIN
a� „, Commission*2073888
aq " Notary Public-California z
Los Angeles County •
M Comm..Ex fres Jul 6,2018 •
•
(Notary Seal)
•
otary Public
3055 Clearview Way San Mateo,CA 94402 T.(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com
AL 05500.AR M-8937.AZ ROC 24377VROC 245450.CA 0518 888104.CO 508041.CT HIC 0632778/ELC 0125305,DC 410514000080/ECC902585.DE 1011120386/71-6032,FL 5013006226,HI 05-29770.IL 15-0052.MA HIC 168572/
EL-1136MR.MD HIC 12894 8/11805.NC 30801-U.NH 0347C/12523M.NJ NJHIC#13VH06160600/34EB01732700.NM EE98-379590,NV NV20121135172/C2-0078648/82-0079719.OH EL 47707,OR C8180498/C562,PA HI CPA077343.RI
AC004714/Reg 38313,TXTECL27006.UT 8726950-5501.VA ELE2705153278.VT EM-05829.WA SOLARC"91901/SOLARC"905P7,Albany 439.Greene A-436.Nassau H2409710000.Putnam PC6041,Rockland 0-11864-40-00-00,Suffolk
52057-H.Westchester WC-26085-013.N.Y.0#2001384-DCA.SCENYC:N.Y.C..Licensed Electrician.#12610.#004485.155 Water St.6th FI..Unit 10.Brooldyn.NY 11201.#2013966-DCA All loans prodded by Sol arCi ty Finance Company.LLC.
CA Finance Lenders License 6054796.SolarCity Finance Company.LLC is licensed by the Delaware State Bank Commissioner to engage in business in Delaware under license number 019422.MD Consumer Loan License 2241.NV
Installment Loan License IL11023/IL11024.RI Licensed Lender#20153103LL.TX Registered Creditor 1400050963-202404.VT Lender License#6766
Ter:4
i 1:1SMOKE I CARBON MONOXIDE ALARMS 1:1
yet
OWNER CERTIFICATE OFCOMPLIANCE
19s4 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTlNO 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)t ft-3333•buildingp.cupertino.orq
Permit No. V-Of-1'6;1
Address 20861 Dunbar Drive Cupertino, CA 95014 (#of Alarms(Smoke} (Carbon Monoxide
PERMIT 045.10T:BE 11'INALEi)AND:COMP :;gTE 3:OWL THIS.00T01CATE'
EAS:BEEPt STGNFD A D:J ETURNJ1l TO Tat in):00J+IG:DIVX$ION
PURPOSE
This affidavit is a self-certification fat the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.112 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and 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 of each separate sleeping area in the immediate vicinity-of the X X
bedroonn(s)
On every level of a dwelling unit including 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.
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 in the.removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarms)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 read and agree to corn&with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
haosheng wang (Signanatta (Date3 .11/2i.r/
Contractor Name: ' J/
Signature Lic.# Date: ...................
Smoke and COform.doc revised 03/18114