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141000010l'A L, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10601 MADERA DR CONTRACTOR: SOLARCITY PERMIT NO: 14100010 OWNER'S NAME: WARNER KEITH S AND LINDA S 3055 CLEARVIEW WAY DATE ISSUED: 10/02/2014 OWNER'S PHONE: 4088927949 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] INSTALLATION OF ROOF MOUNTED SOLAR (26 License Class_ IC. # �'0 (1 MODULES) Contractor Date ' 0 l—a-10 (6063 KW) I hereby affirm at 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 Sq. Ft Floor Area: Valuation: $14000 performance of the work for which this permit is issued. 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: 32635060.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES 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 DAYS FROM 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulat' ns the Cupertino Municipal Code, Section 9.18. " RE -ROOFS: Signature Date 10 q 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 (See.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 Munici 1 Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, a 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: (© Z D2 /114 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO 1/1,186 00/0 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 P% (408) 777-3228 • FAX (408) 777-3333 • buildinq cDcupertino.orq PROJECT ADDRESS 10601 Madera Dr.,Cupertino CA 95014 APN# j - 35 - p�, OWNERNAME Keith Warner PHONE408-892-7949 E-MAIL I STREET ADDRESS 10601 Madera Dr. CITY, STATE, ZIP Cupertino CA 95014 FAX CONTACT NAME Marjan Javanmard PHONE 650.477.6430 E-MAIL mjavanmard@solarcity.com STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 9 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESoIarCity Corporation LICENSE NUMBER 888104 LICENSE TYPE C10 BUS. LIC 428840 V �F COMPANY NAMESoIarCity Corporation E-MAIL mjavanmard@solarcity.com FAX STREET ADDRESS 391 Foster City Blvd CITY' STATE, ZIP Foster City, CA 94404 PHONE 650.477.6430 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ❑ Multi -Family STRUCTURE: /❑` Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ElYes NO PROJECT IN FLOOD ZONE ElYes ?l No 4 SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UMTS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: I Lj 000 DESCRIPTION OF WORK Installation (26) rooftop flush mounted solar panel (6.63) kW ,a RECEIVED BY: �� /� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have reae Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. th ize epresentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ��'` `�� Date: 10-02-14 SUPPLEMENTAL FORMATION REQUIRED OFFICE USE ONLY W OVER-THE-COUNTER c Y F' Y ❑ EXPRESS U S ❑ STANDARD U J ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03/16111 1 CITY OF CUPERTINO IFEE ESTIMATOR - BUILDING DIVISION Y ADDRESS: 10601 Madera Dr. DATE: 10/02/2014 REVIEWED BY: Sean Plan Check Fee: APN: BP#: VV(l *VALUATION: 1$14,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION SOLAR -RES PERMIT TYPE: WORK Installation of roof mounted solar 26 modules 6063 k SCOPE Suppl. Insp. Feer Reg. C) OT NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are only an estimate. Contact the Devi for addn'l info. FEE ITEMS (Fee Resolution 11-053 E, .' 111,113) FEE Ll{Jute' t h,,i h - NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are only an estimate. Contact the Devi for addn'l info. FEE ITEMS (Fee Resolution 11-053 E, .' 111,113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Alternative Energy System $236.00 1PHOTOVRES Photovoltaic System Suppl. PC Fee: Reg. 0 OT 0.0llrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C) OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t"}7i:SP?`I,IC'PlF)t7 t (7'`; i2Cr"1f4 t"ttl`[i 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i Strom Motion Fee: IBSEISMICR $1.82 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.82 $236.00 TOTALFEE.7F $238,82 Revised: 08/20/2014