Loading...
16010007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22561 POPPY DR CONTRACTOR:SOLARCITY PERMIT NO: 16010007 OWNER'S NAME: MAHALINGAM AND VIJAYALAKSHMI MANI 3055 CLEARVIEW WAY DATE ISSUED:01/04/2016 OWNER'S PHONE: 4082521359 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 ®s LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL INSTALL 13 ROOF TOP,FLUSH MOUNTED PV MODULES License Class C O L& Al Lic.# '9<'9 1 Q L+ (3.38 KW) Contractor Date 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:$8000 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:34212006:00 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 DAY 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 Di LED INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities,judgments, ` costs,and expenses which may accrue against said City in consequence of the d ate: granting of this permit. Additionally,the applicant understands and will comply Issue with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. s� RE-ROOFS: Signature Date C/L l 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 ROOFCOVERINGS 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(See.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 255 25533,and 25534. 14 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: t 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 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 deemedrevoked. work's for which this permit is issued(See.3097,Civ C.) 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 0 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 � � �� © (408)777-3228- FAX(408)777-3333 building@cupertino.org /�o /0oo PROJECT ADDRESS 22561 Poppy Dr,Cupertino,CA 95014 United States(SANTA CLARA County) APN# 00 jof OWNERNA4Eg `408/PHONE/ 1 E-MAIL mmanl@yahoo.com Mahalin am Mani 252-1359; STREET ADDREss22561 Poppy Dr CITY, sTATE,ZIP Cupertino, CA 95014 FAX CONTACT NAME Gerry IgtanlocPHONE 650-759-8042 E-MAIL gigtanloc@solarcity.Com STREET ADDRESS 391 Foster City Blvd. CITY,sTATE,ZIP Foster City,CA,94404 FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRAG ❑ ARCHITECT ❑ENGINEER 11DEVELOPER ❑TENANT LICENSE NUMBER 880pTORAGENT 104 LICENSE TYPE c10,c46 Bus.LIC# 28844 CONTRACTORNAME SolarClty Corp. COMPANY NAME SolarClty Corp. E-MAIL gigtanloc@solarclty.com FAX STREET ADDRESS 3055 Clearview Way CITY,sTATE,zIP San Mateo,, CA 94402 PHONE 650-759-8042 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 PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ CommercialURBAN INTERFACE AREA ElYes ElNo FLOOD ZONE ElYes 11NO ❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: 13 KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK Install ( 13 } rooftop mounted solar panels,( 3.38 } KW 12%1-i.2 .i�^}5,. :;sy& 'R, By B m signature below,I certify to each of the following: I am the roe owner or authorized a�gg�,,tt,acton the e owners behalf. I have read thisY Y g Y g P P rtY P g application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c nstructio authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date:: i 1 C-- suPPLEMENTAL INFORMATION REQUIRED g p 5:. Y W OAR[HE C0IJNTER , R", r cANriAttb 5,4 PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22561 POPPY DR DATE: 01/04/2016 REVIEWED BY: 'MELISSA APN: 34212 006 BP#: *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: PERMIT TYPE: WORK INSTALL 13 ROOF TOP FLUSH MOUNTED PV MODULES 3..38 SCOPE Y I 5 r,ernig Fee l''. s..:.P­-reit }r 7 s"y. 'Y. .:F.e7tJti. NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These,fees are based on the relimina information available and are only an estimate. Contact the Dept./or addn'l in o. FEE ITEMS (1 ee Resolutaon 1.1-053.1 f£ ''Ii.13} FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Alternative Energy System Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.(j) Reg. OTJ 0,0 Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 -fan-'. Work Without Permit? 0 Yes (E) No $0.00 Advanced F lanning Fee: $0.00 Select a Non-Residential Building or Structure ' ft, vx, Doi;u91f14.'Pita'fIn Flees a Strong:Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bld.gStds Commission Fee: IBCBSC $1.00 SITBTUTALS $2A4 $236.00 TOTAL > $238.04 Revised: 10/01/2015