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B-2016-3244CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3244 1574 POPPY WAY CUPERTINO, CA 95014-5307 (366 10 108) SOLARCITY CORPORATION SAN MATEO, CA 94402 OWNER'S NAME CHANG MING HSUNG AND KU SHU FEN I I DATE ISSUED: 12/09/2016 IOWNER'S PHONE; 408-677-3459 I I PHONE NO: (650)963-5100 LICENSED CONTRACTOR'S DECARATION License Class C-1 O:C-46 Lic. #$88104 Contractor SOLARCITY CORPORATION Date 12/31/2016 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: r. 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. �i `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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 12/9/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). BUILDING PERMIT INFO: X BLDG ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 18 -PANEL ROOF MOUNTED PV SYSTEM (5.67 KW); INSTALL ROOF STRUTS Sq. Ft Floor Area; Valuation: $10000.00 APN Number: Occupancy Type: 36610108 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAyende Date: 12/09/2016 RE -ROOFS: 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. Signature of Applicant: Date: 12/9/2016 I hereby affirm under penalty of perjury one of the following three declarations:I ALL ROOF 1. I have and will maintain a Certificate of Consent to setf-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. 2. 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. 3. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION certify that l 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 12/9/2016 CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California health & Safety Code, Sections 25505; 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code ections 25505, 25533, and 25534. Owner or authorized agent: Date: 12/9/2016 CON CTINLEJNG AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-333.3 building(a.cupertino.org PROJECT ADDRESS l _111-41 p ,/gy p y 9 .J F11 APN # 3/ G p 10 - i C9 OWNERNAME M� .ry i Cva ,( ,r,•! .. - � `� L"� /�,�jJ PHOqogNE g `2 `l 1. STREET ADDRESS j p P�� oo tigy CITY, SGT A' ZIP _ � tjv. 0- A `T !25 FAX CONTACT NAME Gerry lgtanloc PHDNE650-759-8042 E-MAILgigtanloc@solarcity.com STREET ADDRESS 391 Foster City Blvd. CITY, STATE., ZIP Foster City,CA,94404' FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 9 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMESOlarh.Ity Corp. LICENSE NUMBER88810i1 LICENSE TYPEC10,C46 BUS. LIC #28844 COMPANY NAMESoc1arCitty Corp.. E-MAILgigtanloc@solarcity.com FAX STREETADDREss3055 Clearview Way CITY, STATE, ZIP San Mateo, CA 94402 PHONE650-759-8042 ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ❑ Multi -Family STRUCTURE: r-1Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑. NO PROJECT IN FLOOD.zONE ❑ Yes - ❑. NO V OLAR PANELS. ❑ ELECTRIC VEHICLE CHARGING STATION 7E] OLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELSIUNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL V ALUATIOb as DESCRIPTION OF WORK .- install (, ) rooftop mounted solar panels,( '4�� ) KW S' MI I r/f f 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 h ve read this 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 construction. I authorize representatives of Cupertino to enter the above -identified property rinspection purposes. �� ®Ct ! C�, 'l Signature of ApplicantfAgent: Date: / SUPPLEMENTAL INFORMATION REQUIRED .`)1vL . 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