B-2016-3086 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3086
19691 DRAKE DR CUPERTINO,CA 95014-2433(316 32 033) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: BANDI SAPAN N AND JAIN SANDIYA DATE ISSUED:11/09/2016
OWNER'S PHONE:650-430-1270 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:C-46:B Lic.#888104
Contractor SOLARCITY CORPORATION.Date 12)31/2016 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)12-PANEL ROOF MOUNTED PV SYSTEM(3.78 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
t� 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. Sq.Ft Floor Area: Valuation:$6000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 32 033
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City a stands and the hg of this permit.
int 'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulationsper the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
C/tSignature Date 11/9/2016 Issued by:Abby Ayende
Date:11/09/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/9/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2 I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se ' ns 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. G"Owner or authorized agent:
APPLICANT CERTIFICATION Date:11/9/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 11/9/2016 Licensed
Professional
\\ 1 //. ALTERNATIVE ENERGY PERMIT APPLICATION AE
rt9COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�Sc,rvsr 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333-building@cupertino.orq
PROJECT
f �iS C [1 :A _ APN# , J
OWNER NAME PHONE E-MAIL ,
.� e, ',.9 3) - 12 40 <,,t{A- , .
STREET ADDRESS' CITY,STATE,ZIP FAX
02_
CONTACT NAME Gerry Igtanloc PHONE 650-759-8042 E-MAIL gigtanloc@solarcty.com
STREET ADDRESS 391 Foster City Blvd. CITY,STATE,ZIP Foster City PAX
❑OWNER. 0 QWNER-BUILDER 0 OWNER AGENT IR CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CON'TRACTORNAME. SolarCityCorp. ICENSE NUMBER 888104 LICENSE TYPE BUS.LIC#
p• C.10,C46,B 2 a✓( Ll
COMPANY NAME SolarCity Corp. E-MAIL gigtanloc@solarcity.com FAX
STREET ADDRESS 3055 Clearview Way CITY,STATE,ZIP San Mateo,CA 94402 PHOS 650-759-8042
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE.OF IX SFD or Duplex 0 Multi-Farrlily PROJECT IN WILDLANDPROJECT IN
STRUCTURE: 0. Commercial URBAN INTERFACE AREA ❑ Yes [2.
No FLOOD ZONE 0 Yes r No
Ut SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING - 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS. KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK Install.( ('2. )roof mounted solar panels. ('s )KW.
.
- ' .:,,-,/ -,-a- -
R8G I3
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ing construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: / L SUPPLEMENTAL INFORMATION REQUIRED
OFFICE=USE ONLY ..
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PVApp 2011.doc revised 03/16/11