B-2018-0028 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0028
21513 CONRADIA CT CUPERTINO,CA 95014-4801(356 23 049) TESLA ENERGY
OPERATIONS,INC.
FREMONT,CA 94555
OWNER'S NAME:VANDROVEC PETR ET AL DATE ISSUED:01/09/2018
OWNER'S PHONE: PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C49 Lia#888104
Contractor TESLA ENERGY OPERATIONS INC Date 12/31/2018 X BLDG X ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
1 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)33 PANEL ROOF MOUNTED PV SYSTEM(10.75 KW);(N)125
I hereby affirm under penalty of perjury one ofthe following two declarations; AMP LOAD CENTER;(N)200 DISTRIBUTION PANEL;(N)2-ENERGY
1. 1 have and will maintain a certificate of consent to self-insure for Worker's STORAGE
Compensation,as provided for by Section 3700 of the Labor Code,for die REV#1:REMOVE ENERGY STORAGE SYSTEMS AND LOAD AND
performance ofthe work for which this permit is issued. DISTRIBUTION PANELS AND INSTALL(N)225 AMP LOAD CENTER
IN 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by -ISSUED 06/2t/2018
1,\\\JtwJ� Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valentina:$15873.00
APPLICANTCERTIFICATION
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 35623 049
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 ah t said City Inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,thea licant understands and will comply with all non-point
source regulati s he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 06/21/2018 Issued by:Jasmine Archbold
Date:01/09/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt front the Contractor's License Lav for one of the RE-ROOFS:
fallowing two reasons: Ali roofs shall be inspected prior to any roofing material being installed.If a root'is
t, 1,as owner of the properly,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
ampensmkin,will do the work,and the structure usual intended or offered for inspection.
sale(Sce.7044,Business&Professions Cade)
2. 1,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code). Date:06/21/2018
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
Pat formance of the work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 ofthe
Section 3700 of the Labor Code,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(a)slmnld 1 sten,m handle hazardous
shall not employ any person in any manner so as to become subject to the mater..[.Additionally,should 1 use equipment or devices which emit hazardous
air eontamimmts 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 Co g,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall `I
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Data:06/21/2018
I certify that I have read this application and slate that the above Information Is CONSTRUCTION LENDING 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, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 06/21!2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0028
21513 CONRADIA CT CUPERTINO, CA 95014-4801 (356 23 049) SOLARCITY
OWNER'S NAME:
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class B. C10, C46 Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
1 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.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
is issued.
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
and state laws relating to building construction, and hereby authorize
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
may accrue agbinst said City in consequence of the granting of this permit.
Additionally, the licant understands and will comply with all non -point
source
I hereby affirm that 1 am exempt from the Contractor's License Law for one of the
following two reasons:
t. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
2. 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.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, l become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 1/09/2018
SAN MATEO, CA 94402
DATE ISSUED: 01/09/2018
PHONE NO: (
BUILDING PERMIT INFO:
BLDG X ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) 33 PANEL ROOF MOUNTED PV SYSTEM (10.75 KW); (N) 125
AMP LOAD CENTER; (N) 200 DISTRIBUTION PANEL; (N) 2 -ENERGY
STORAGE
Sq. Ft Floor Area: I Valuation: $15873.00
APN Number: Occupancy Type:
356 23 049
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApplicant:
Date: 1/09/2018
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety
Owner or authorized agent:
Date: 1/09/2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHI'TECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional