13020004 CITE' OF CUPIERTINO RU�LDIING PERMIT
BUILDING ADDRESS: 10303 MINER PL CONTRACTOR:SOLARCITY PERMIT NO: 13020004
OWNER'S NAME: NORMAN ABRAMOVITZ 3055 CLEARVIEW WAY DATE ISSUED:02/10/2013
OWNER'S PHONE: 4082554469 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
ff-
License Class t_, 6 Lie.4 a,F�?104 INSTALL 36 ROOF TOP FLUSH MOUNTED SOLAR
PANELS
Contractor Date << l3 8,64 Key
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. REVISION#1-REVISE PANELS AND KW-ISDD OTC
I hereby affirm under penalty of perjury one of the following two declarations: 9/11/2013
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. Sq.Ft Floor Area: Valuation:$40000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31646031.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is bJ P]�,j, j j[T j�,XPgjt)�,S I WORK IS NOT STARTEgDcorrect. I agree to comply with all city and county ordinances and stat e �lj �WI•I'IT�N IyA�'S®$+ PERMIT ISSUANCE OR
to building construction,and hereby authorize representatiWlib ,
upon the above mentioned property for inspection purposesave 180 DAY R M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino againsjudgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulation he Cupertino Municipal Code,Section
9.18.
, � 1' f 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-BUfLDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
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
1 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(x)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
have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 553 25534.
Section 3700 of the Labor Code,for the performance of the work for which this A/f
permit is issued. Owner or authorized age [e:
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 beeome subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUMON 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
CI'T'Y OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 10303 MINER PL CONTRACTOR:SOLARCITY PERMIT NO: 13020004
OWNER'S NAME: NORMAN ABRAMOVITZ 3055 CLEARVIEW WAY DATE ISSUED.02/20/2013
OWNER'S PHONE: 4082554469 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION; RESIDENTIAL COMMERCIAL
License Class C Li.. INSTALL 36 ROOF TOP FLUSH MOUNTED SOLAR
PANELS
Contractor -f-CJ Date 2(2.UT 8.64 KW
I hereby affirm that 1 am licensed under the provisions of Chapter 9 2ND SUBMITTAL IN ON 2/12/2012
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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:$40000
1 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:31646031.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES RK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D OE RIVIIT 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 OM T O ED 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 2 .�
granting of this permit. Additionally,the applicant understands and will comply Iss 2:� Daby:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� RE-ROOFS:
Signature �,Q /l�S/ Date 2 2 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
I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant; Date:
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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 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 1 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 1
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,Sections 25505,25533,and 25534. - /
Section 3700 of the Labor Code,for the performance of the work for which this C� /� _ /17q 7
permit is issued. Owner or authorized agent: [l— — Date: "'►►►
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,1 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 CUP ERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10303 Miner Place DATE: 02f04f2013 REVIEWED BY: jsg
APN: BP#: 000 `VALUATION:
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY SFD or Duplex ____[PENTAMATION SOLAR-RES
USE: PERMIT TYPE:
WORK i
SCOPE
kle ch. Plan Check Pbunh. Plan,Check F.lee..Plan Check
FAIIIII-11. Permit F'ee, plumb. Permit Fee: Flec.Permit Pee:Other,lfeeh.Insp. Other Plumb Insp. 01her fp. Insp,
Ll I
ED-L-
Alech. Insp. Fee: Plumb, Insp. Fee: Flee, Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These,fees are based on the relimina information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-05.1 ff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 ) # Alternative Energy System
Suppl. PC Fee: 8 Reg. 8 OT Q.Q hrs $0.00 $219.00 lPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. () OT Q Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ConswuCtion 741.y:
Adfninistralive.Fee: 0
Work Without Permit? Yes No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Ti and Documentation Fees:
Building or Structure
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $219.00 TOTAL FEE: $219,00
Revised: 01101/2013
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 C� A E
CUPEitTIWC (408)777-3228 • FAX(408) 777-3333 •buildingpcupertino,org ,0
PROJEC-i ADD APN if 21 o t'+ Q3
1 ✓ —T tV
OWNER NA� (� DE-MAS Q 1�n
J VA I/� �A .V i
STREET ADDRESS Q Y� Q�/ Cm. AIE, �/ �] / FkX
MW JJ 1 (� �V` t.v
CONTACCNAME w S� PHONE E-MAR
l ��I
STREET ADO RESS CITY.STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑7ENANT
CONTRACTOR NAME 1 LICENSE NUMBER �p-�j a LICENSE TYPE,'1 / BUS.LI�M
! _1L a Baa f `7
COW ANY NA.MF. ,q_!�LL V
- E EL I 6�Q,vcl� AX 6- 7�-,zrz-lazy
jj 111 1
STREET ADQjg1 /ri J U r t:ITY TE. ^.- VVO P T)'_ 3 [ 3 7
(_ I r!1 7
ARCFB-IECTIENGINEERNA IE LICENSE NUMBER BUS.LIC N
COMPANY NAME E•MAB. FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
USE of SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
MUCTUME ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
SOLAR PANELS ❑ ELECTRJC VEHICLE CHARGING STATION ❑ SOLAR WATER DATING ❑ Ui R.
FORSOL P PANELS: NUMBEROF PANELS/t1N7S. 7 KILOWATTS( / TOTAL VALVA-n
DESCRIPMON OF WORK (, /YJn
c� - a U Dvv1, d
RECEIVED BY'
By my signature below,i certify to each of the following I am the p perry owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have rovi is correc I have rea the Description of ark and vera it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to i i onstruc@o I authori a rep esenta ve Cupertino to enter the above-identified pproperry for inspection purposes-
SignatureofApplicantlAgent: Date:
S PLEMENTA ORIIMATTONREQUTRED oMCE USE only
' •'❑ .OVfiR=YFiE-COU1vTER .:
STANDARD
z ❑ LARGE
❑ �WAJOFt
PVApp_1011.doc revised 03116111