11120048CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10440 IMPERIAL AVE
CONTRACTOR: SOLARCITY
PERMIT NO: 11120048
OWNER'S NAME:
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
F
r— ELECT F
License Class
Business & Professions
MOUNT, 20 PANELS, 4.7 KW
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: $25000
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35719090.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionilly, the applicant understands and will comply
with all non -point source regulati ns pe he Cupertino unicipal Code, Section
9.18.
Issued by: Date: 1-,2-
Signature-
RE -ROOF$:
OWNER-BeILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETFER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the C erti 0 Municipal Code, Chapter 9.12 and the
Health & Safety Code, S tions K505,75533, a ' 25534.
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.
7-
UCTIO L
ONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
I I
CITY OF CUPERTINO
WN FEE ESTIMATOR — BUILDING DIVISION
1AADDRESS:
10440 imperial ave.
DATE: 12/07/2011
REVIEWED BV: bobs.
APN- - —FBP#:
*VALUATION: 1$25,000
*PERMIT TVPE: Building Permit
PLAN CHECK TVPE: Alteration / Repair
PRIMARV SFD or Duplex
USE:
Suppl. PC Fee: (E) Reg. 0 OT
PENTAMATION SOLAR -RES
PERMIT TYPE -
WORK
install solar panel at ex. sfd rooftop mount.
SCOPE
NOTE. This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Mtrict. etc-). These tees are hased on the nrefininary infarnmdan available and are aniv an estimate- Contact the Dent for addnl info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee:
$0.00
F__� #
$214.001
Alternative Energy System
iPHOTOV;;S� Photovoltaic System
Suppl. PC Fee: (E) Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg.
0 OT
00
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
............ .. .. . ..........
E)
Work Without Permit? C) Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Stromz Motion Fee:
IBSEISA17CR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
. .... ...... ................
. . .
........
. ..... .
P.50
$214.001
r P.. -f V
$217.501
Revised: 10/01/2011