13070175 MY OF CUP E][8TRNO Buff Ll1:DffNG P ERMT
BUILDING ADDRESS: 21929 OAKDELL PL CONTRACTOR:SOLARCITY PERMIT NO:13070175
OWNER'S NAME: CHANDLER TIMOTHY R.F AND ZAMOONNA 3055 CLEARVIEW WAY DATE ISSUED:07/29/2013
OWNER'S PHONE: 6508772337 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# �� INSTALL 13 ROOFTOP F LUS�IHi�[OUN'II'PV PANELS ON(E)
SIFIIDW L 3.185 KW
Contractor !e L� Date ��` r 10/1/13 REVISION#2-OTC APPROVAL FOR PANEL
I hereby affirm that I am licensed under the provisions of Chapter 9 CHANGE )4re)7f aLfs- d
(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:
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:$13000
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:32639001.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 Ili®��� � �.�,ISSUANCE ®�
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 1180 D 1A 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
granting of this permit. Additionally,the applicant understands and will comply sue Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �
RE-ROOFS:
Signa re __ Dated 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 I am exempt from the Contractor's License Law for one of �Si
gnature 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)
I,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. 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 1 store or handle hazardous
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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co tens 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Q•/ .
permit is issued. Owner or authorized Date:
I certify that in the performance of the work for which this permit is issued,1 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,1 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 BUILDffNG PERMIT
BUILDING ADDRESS: 21929 OAKDELL PL CONTRACTOR:SOLARCITY PERMIT NO: 13070175
OWNER'S NAME: CHANDLER TIMOTHY R.F AND ZAMOONNA 3055 CLEARVIEW WAY DATE ISSUED:07/29/2013
OWNER'S PHONE: 6508772337 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION. RESIDENTIAL El COMMERCIALS
License Class�-�{ ./tQ Lic.# 5<50ve� INSTALL 13 ROOFTOP lF1LUS]H[M[OUNT]PV PANELS ON(lE)
SFDWL33 s�V, ,
Contractor `j7S ,�� � Date �J,A 62J
I hereby affirm that I am licensed under the provisio s of apter 9 f
(commencing with Section 7000)of Division 3 of the Business&Professions C/ld(✓/ 9003 /,7}�
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$13000
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 AP N Number:32639001.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT IT)Ci XPIR]ES IFF WORK IS NOT STARTED
Ei D
correct.I agree to comply with all city and county ordinances and state laws relating W�� r �®ll�A�S ®�PERMIT ISSUANCE ®�
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 DAYS lF OM[(LAST CALLED IINSPE l�l[0N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the �-y
granting of this permit. Additional) the Leant understands and will comply Issued by: Date:
g' g P Y, PP P Y
with all non-point source regulations perthe 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)
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
II 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,Sections 25505,25533,an ,25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
1 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 ECUPERTINO
FEE IESTRMATOR- BUILDING DIVISION
MAADDRESS:
21929 oakdell pl DATE: 07/29/2013 REVIEWED BY: Mendez
PN: BP#: .�J'��/ ,j� *VALUATION: 1$13,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: SOLAR-RES
WORK install 13 rooftop flushmount pv panels one sfdwl 3.185 kw
SCOPE
Mecli. Plan Check Phorrb, Plan Cheek Elec.Plan Check
i—f-A Permlil Fee: Phimb. Permit Fee: li;lec. Permit Fee.
01her Afech. Insp. Other Plumb Insp. Other Elee.Insp, Li
:tdech.Insp. IFe:e: Plumb. Insp. Fee: Elec.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 ees are based on the prelimina information available and are onl an estimate. Contact the De t or addn 7 in o.
FEE ITEMS (Fee Resolution 11-053 f f 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Alternative Energy System
Suppl. PC Fee: E) Reg. 0 OT 1 0.0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System'
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-(E) Reg. OT 5LOL-!!S— $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Con,mwction.Tax: C
Administrative Fee:
Work Without Permit? 0 Yes E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure
I
Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.30 $229.00 TOTAL FEE: $231.30
Revised: 07/01/2013