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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1150 STAFFORD DR CONTRACTOR:SOLARCITY PERMIT NO: 10090087
OWNER'S NAME: RAJA VENKATESH 393 VINTAGE PARK DR STE 140 DATE ISSUED:09/20/2010
OWNER'S PHONE: 4083143320 FOSTER CITY,CA 94404 PHONE NO:(650)638-1028
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Classczl1 ,,C/o,6Lic.# 10,41 5.67 ROOF MOUNT PHOTOVOLTAIC SYSTEM,27
PANELSIUNITS
Contractor ����! ���� Date 9-ZC)s Zd"0
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:$27000
1 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:36207006.00 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1
costs,and expenses which may accrue against said City in consequence of ther U
granting of this permit. Additionally,the applicant understands and will comply Issued by: 1Z J— Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
1,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 5505, 533, rd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:Qi-7c� -
zci;J
I certify that in the performance of the work for which this permit is issued,l 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,1 CONSTRUCTION LENDING AGENCY
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
1 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, ARCHITECT'S DECLARATION
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 re ulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date y-Zc� Z�iij
CITY OF CUPERTINO
SOLAR PANEL
COF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
�� Z 0 ,1 066
Building Address:
Owner's Name: Phone #:
24% �1e r �+ 48 - - 3�
Contractor: Phone#: 650 635 Io2g Contractor License#:
Fax #: 656> 63e /0—,-,q oee
Contact: Phone#: 6 Sz) zzz 9 21":10 Cupertino Business License#:
Fax #: 6s 0 6m fa 2 i_3e e1 41
Number of Panels/tJnits: Kilowatts (Commercial Only):
2-J
Job Description:
5. 6-"1 Fv ski ,G S e�
Project Size: Express ❑ Standard ❑ Large Major❑
Residential Commercial ❑ Valuation (cost of project):
12
Green Points:
1.2 KW-6 Points ❑ 2.4 KW- 12 Points ❑ 3.6 KW- 18 Points
Quantity Fee ID Fee Description Fee Permit Type
Group
1SOLARPANL Commercial Solar Panel E SOLAR-COMM
1PHOTOVCOM Photovoltaic System E
Commercial/Multi-family
1BSEISMICO Seismic Commercial E
1ELCPLNCK Plan Check Fee E
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee COMM & RESID
1 SOLARRES Residential Solar Panel E SOLAR-RES
Revised 07/06/09
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOBADDRESS: PERMIT# 1?06
OWNER'S NAME: t^ PHONE# �O7—`d
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: cst v CITY/ZIPCODE:
*Our municipal code requi s all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ow r/Contractor Signature Date