13110008 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21885 ALMADEN AVE CONTRACTOR:SOLARCITY PERMIT NO:13110008
OWNER'S NAME:
SAN MATEO,CA 94402 PHONE NO:(650)638-1028
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F1COMMERCIAL[]
License Class Lic.# 0-19 t®L INSTALL 28 ROOFTOP FLUSH MOUNTED SOLAR PANELS
Contractor S �l`'�1 Date jt2 t i (7K�
l
I hereby affirm that I am licensed under the provisions of Chapter 9 REVISION#1-ELECTRICAL TIE IN-ISSD OTC 11/22/201
(commencing with Section 7000)of Division 3 of the Business&Professions
RE S ON
Code and that my license is in full force and effect.
DATE
I hereby affirm under penalty of perjury one of the following two declarations: -�
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. Sq.Ft Floor Area: Valuation:$28000
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 APN Number:35715090.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 D=M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. `
q -2Z 3 RE-ROOFS:
Signature to 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.
❑. OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio=2555,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent:
permit is issued.
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21885 ALMADEN AVE CONTRACTOR:SOLARCITY PERMIT NO:13110008
OWNER'S NAME:
SAN MATEO,CA 94402 PHONE NO:(650)638-1028
ICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class, INSTALL 28 ROOFTOP FLUSH MOUNTED SOLAR PANELS
� �`�s� Lio.# �r t_ � ?
(7KW)
Contractor - %E . Date 1—I
`
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
'J performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$28000
l,have and will maintain Worker's Compensation Insurance,as provided for by
F Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35715090.00 Occupancy Type:
r
�- ,permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 D QOM LAST CALLED INSPECTION.
indemnify,and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Date f
granting of this.permit. Additionally,the applicant understands and will comply su y: "`
with,all non-point source regula ions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date/� 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cede,,Sectiens 25505,,25 25534.
Section 3700 of the Labor Code,for the performance of the work for which this //
Owner or authorized-agent y r Date.//
permit is issued.
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,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21885 ALMADEN AVE DATE: 11/04/2013 REVIEWED BY: MELISSA
APN: 357 15 090 BP#: EVALUATION: $28,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RES
USE: p PERMIT TYPE: i
WORK INSTALL 28 ROOFTOP FLUSH MOUNTED SOLAR PANELS 7kW
SCOPE
ech. Plan Check Phvnb.Plan Checti- Elec.Plan Check
1Llech.Permit Fee: Flumh.Perni7 Pee: Elec. Permit Fee:
FOther Afech.Insp. Other Plumb Insp. Li Ocher Glee.Imp.
F'0"'
Insp.Fee: Plumb. Insp. Fee: Elec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onl an estimate Contact the Det or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl.PC Fee: 0 Reg. ® OT 0.0 hrs $0.00 $229.00 1PxoTOVREs Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-(F) Reg. ® OT r070 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consiruciion 1 x:
-T
11dinini.strati ve.1,eco: 0
Work Without Permit? ® Yes ,E) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure 0
i
Strom Motion Fee: IBSEISMICR $2.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $4.80 $229.00 TOTAL FEE: $233.80
Revised: 10/01/2013