13060027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1013 WESTLYNN WAY
CONTRACTOR: SOLARCITY
PERMIT NO: 13060027
OWNER'S NAME:
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
LICENSED CONTRACTOR'S DECLARATION
Lie. #
INSTALL 12 FLUSH MOUNTED ROOFTOP PV PANELS
License Class._
�J
�` -Date � /
Contractor > --"' ' `{ ` � �'
(2.94KW).
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: $12000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35926042.00
Occupancy Type:
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
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
180 DAYS FROM LA STALLED INSPECTION.
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
�byllDate: 6Z6
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sourcexegutati ns per the Cupertino Municipal Code, Section
RE -ROOFS:
being installed, If a roof is
9.18.
Signature Date
All roofs shall be inspected prior to any roofing material
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
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. 1 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 Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections
Date:
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked,
Lenders 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
FEE ESTIMATOR — BUILDING DIVISION
1013 WESTLYNN WAY
DATE: 06/04/2013
REVIEWED BY: MELISSA
jArADDRESS:
PN: 359 26 042
BM.: l ?jd o
*VALUATION: $12,000
xPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
PENTAMATION SOLAR-RES
PERMIT TYPE:
USE:
WORK I
INSTALL 12 FLUSH MOUNTED ROOFTOP PV PANELS 2.94kW .
SCOPE
Xfcch7klech.
Phunb. Plan hcc)c
Elect. Phn Check
Peintrt Fee:
Phirb. Perirxi7 ! re;
Glec. Permh Pee:
Othe
Other Phtmb hasp.
Other Elcc. Insp.
ltlech. Insp. Fee:
Plumb. hap. Yee.
Dec Insp, Fee:
SI 1
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanuary Sever Distract, c aoo
I l' rmation available and are onlyan estimate Contact the Dept or addn'l into.
Distract, etc . These ees are based on t ae re rnnnar
FEE ITEMS (Fee Resolution 11-053 Eff. 7/U12)
an o
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
L J # Alternative Energy System
$219.00 IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Q 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
Gonsfrliction Tax: _F__T
Adi n-Piistrot/ve Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure
A
Trm,el Docinuenlolion Fees
Strong Motion Fee: IBSEISMICR
$1.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.20
$219.00 TOTAL FEE:
$221.20
Revised: 04/29/2013