11080220CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10740 JOHNSON AVE CONTRACTOR: SOLARCITY PERMIT NO: 11080220
OWNER'S NAME:
SAN MATEO, CA 94402 PHONE NO: (650) 638-102B
KLICENSED CONTRACTOR'S DECLARATION
License Class C Y& 1, C-10 Lic. # SW/6
Contractor SL� Date ?"_3 C)::/�
I hereby affirm that I am licensed Ader 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 effecL
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.
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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulat per e Cupertino Municipal Code, Section
9.18. / A �t I — I
11-IM1111111! . -
11 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB V_
MECH F RESIDENTIAL F COMMERCIAL r—
JOB DESCRIPTION: INSTALL FLUSH -MOUNTED SOLAR PANELS(I 9) AT
EXISTING
SINGLE FAMILY DWELLING ROOFTOP 3.87KW
Sq. Ft Floor Area: I Valuation: $2 1000
APN Numher: 37531007.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date: F—F,,A 6,
RE -ROOFS:
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 al I new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Seefions 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Cod ectio 25505, 25533, and 25534.
Ow
YCONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Mork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATIO
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
imlADDRESS:
10740 johnson ave.
I DATE: 08/30/2011
REVIEWED BY: bobs.
APN:
I BP#:
'VALUATION: j$21,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (F) . Reg. 0 OT
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
panels at ex sfd rooftop.
SCOPE
��solar
NOTE.- These tees are haved an the nrolindnary information availahle and are on1v an estimate. Contact the Dent for addnl info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$214.001
Alternative Energy System
JPHOTOVRES Photovoltaic System
Suppl. PC Fee: (F) . Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes E) No
$0.00
0
(F)
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
If � '10, �, I
StrODR.M.otion Fee: IBSEISMCR
$2.10
Select an Administrative Item
131day Stds C mmission Fee: IBCBSC
$1.001
�.- V. I I. P_ 111 - I , . I .', �, '� . � � . - " "' " .
.......... ......
----
3.1 01
-- - -------
$214.00
$217.10]
Revised: 07/04/2011