13050219 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; 10670 MERRIMAN RD CONTRACTOR:SOLARCITY PERMIT NO: 13050219
OWNER'S NAME: RAGHURAMA BHAT 3055 CLEARVIEW WAY DATE ISSUED:06/04/2013
OWNER'S PHONE: 4087187059 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL11
License Class Cir& Lic.# g1�C6 I by INSTALL 14 FLUSH MONTED ROOF TOP SOLAR PANELS,
Contractor
50 (Af C:lx Date 12 3.43 KW
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$14000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34216140.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that i have read this application and state that the above information is PERMIT EXPIRESIF
ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save I$ ST CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Ll
granting of this permit. A itionally,the applicant understands and will comply Iss Date:
with all non-point sour re ulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date G� �� 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.
El ER-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 Cupr 'no Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se S ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a nt: Date: 3
permit is issued.
I certify that in the performance of the work for which this permit is issued,l 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 1 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,Seetion Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10670 merriman rd DATE: 05/3112013 REVIEWED BY: mendez
APN: BP#: /�QS��� 'VALUATION: 1$14,000
;PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration ! Repair
PRIMARY SFD or Duplex PENTAMATION SOLAR-RE
USE: PERMIT TYPE: i
Fz
ORK install 14 flush monted roof to solar anels 3.43 kw
COPE
Xfech, Flan Check Plumb. Plan Check Elec. Plan Check
hlech. Permit Fee' Plumb. Permit Fee: Elec. Permit Fee:
Other hfech. Inas. 01her Plumb Insp, Ll 01her Elec. Insp._E3_t__
Afech. Insp. Fee: Plumb. hrsp. Fee: Elec.Insp.FCC:
NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). These ees are based on the preliWna information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053&_ 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppi. PC Fee: - (j) Reg. OT 0.0 1 hrs $0.00 $219.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl: Insp. Fee Q Reg. Q OT O
.01 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
GOnso irclion .Tai.
Adinhiistrative.Fee: Q
Work Without Permit? Yes (j) No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential Q
Travel Documenlarion Fees: Building or Structure
i
Strong Motion Fee: IBSEISARCR $1.40 Select an Administrative Item
Bldg Stds Commission Fee: /BCBSC $1.00
SUBTOTALS: $2.40 $219.00 TOTAL FEE: $221.40
Revised: 04129/2013