13070163CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20659 SHELLY DR
CONTRACTOR: SOLARCITY
PERMIT NO: 13070163
OWNER'S NAME: SQUARCIA LARRY G AND YOLANDA
3055 CLEARVIEW WAY
DATE ISSUED: 07/25/2013
OWNER'S PHONE: 4083147575
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
License Class Lie. # /ni�
INSTALL 25 ROOF TOP MOUNTED SOLAR PANELS (6.125
—��1�'��
KW)
ContractorDate ,2
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
Sq. Ft Floor Area:
Valuation: $25000
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: 35911024.00
Occupancy Type:
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
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FRO LLED 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
/ ®�
Date:
granting of this permit. Additionally, the applicant understands and will comply
ued y:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
,.C/
RE -ROOFS:
Signature _ Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
a
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Cj 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 (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 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
l /
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
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
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
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1_ The.co fees are hated an the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1,/12)
ESS: 20659 SHELLY DR
FAPN:
DATE: 07/25/2013
REVIEWED BY: MELISSA
359 11 024
BP#: i 'i'
*VALUATION: 1$25,000
Other Pl dmh, ln5p.
i iiWi£ Elec. Insf).
T'tc
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
PME Plan Check:
PENTAMATION SOLAR -RE
USE:
PERMIT TYPE:
WORKINSTALL
25 ROOF TOP MOUNTED SOLAR PANELS 6.125 kW
$0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
SCOPE
hrs
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1_ The.co fees are hated an the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1,/12)
We Hari Cheek
11hi trb. Plan Check
Lice. Pharr Check
Plamh. Pr c
6;lec Permit fee:
01her !Meth. Insp.
Other Pl dmh, ln5p.
i iiWi£ Elec. Insf).
T'tc
:ec. lm_p t"CC�
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1_ The.co fees are hated an the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1,/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$229.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (j) Reg. 0 OT
0.0hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conso- etion Tax:
.ld}ninistrativ Fee:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced PlanningFee.
$0.00
Select a Non -Residential
or Structure
0
A
Ctucel Z)ocutrte:ntutiUn Fees:Building
Strom Motion Fee. 1BSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$3.50
$229.00
TOTAL FEE:
$232.50
Revised: 07/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20659 SHELLY DR
CONTRACTOR: SOLARCITY
PERMIT NO: 13070163
OWNER'S NAME: SQUARCIA LARRY G AND YOLANDA
3055CLEARVIEW WAY
DATE ISSUED: 07/25/2013
OWNER'S PHONE: 4083147575
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
XLICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALE]
License Class C`- 4S_ Lie. #-'-7.✓5" 416 Z
INSTALL 25 ROOF TOP MOUNTED SOLAR PANELS (6.125
rr JJ
Contractor Date
,f
KVO
I hereby affirm th t 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: $25000
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35911024.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. nt 1 / '�
�/
ERTIFICATION
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
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA F M 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
77
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point so ce regulations per the Cupertino Municipal Code, Section
9.18.
�'7
Date ' 3
RE -ROOFS:
be inspected to roofing material being installed. If a roof is
Signature /
All roofs shall prior any
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 (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.1044, 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(x) 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
for the for which this
will maintain compliance with Ae Cupe ino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec ns 255 5, 25533, and 25534.
11 1
Section 3700 of the Labor Code, the performance of work
Owner or authorized agent: 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
CONST UCTION LENDING AGENCY
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
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
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