15060068 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20199 PACIFICA DR CONTRACTOR:SOLARCITY PERMIT NO: 15060068
OWNER'S NAME: BHUPINDER KHATTRI 3055 CLEARVIEW WAY DATE ISSUED:06/09/2015
OW,'ER'S PHONE: 6502246646 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
INSTALL 36 ROOF TOP,FLUSH MOUNTED PV MODULES
License Class C(�Lo Lic.4 ym { C, 61 (9.36 KW)&INSTALL(N) 125 AMP SUB PANEL IN SIDE
1
Contractor I I +� Date (. / Z rj YARD(AROUND THE CORNER FROM(E)MAIN)
r, c�f
I hereby affirm that I ant 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:$19000
�1 1 have and will maintain Worker's Compensation Insurance,as provided for by
U Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36929011 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 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 LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may ccrue against said City in consequence of the /J
granting of this permit. Add' nallyf a applicant understands and will comply
with all non-point source re labor{ er the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date C� t 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 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)
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
1 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 Are it Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertfr< Mu�lcipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505_5553;and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this � ✓ /
permit is issued. Owner or authorized agent: Date: �4
I certify that in the performance of the work for which this permit is issued,1 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,1 must 1 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
h
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 A'E
408%777-3228 • FAX (408)777-3333 •buildina(c7cupertino.ora �n Cyt
CUPERTINO
PROJECT ADDRESS C,( c.t �" l yC� APN 9
OWNER NAME PHONE c c E-MAIL
iJnC:
STREET ADDRESS
[TY,STATE,ZIP ` FAX
CONTACT NAME Marjan Javanmard PHONE 650.477.6430 E-MAIL mjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd CITY,STATE, ZIP Foster City, CA 94404 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 19 CONTRACTOR AGENT . ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMESOIarCity Corporation LICENSE NUMBER 888104 LICENSE TYPE C10 BUS.LIC g28840
COMPANY NAMESOIarCity Corporation E-MAIL mjavanmard@solarcity.com FAX
STREET ADDRESS 391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 PHONE 650.477.6430
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STR CTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 36 KILOWATTS(COMMERCIAL ONLY): -/ 3/' TOTAL VALUATION: C1
DESCRIPTION OF WORK ( �o
Installation (36 ) rooftop flush mounted solar panel ( .36) kW
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IT
By my signature below,]certify to each of the following: I am the prope ovine Ized agent to a e prop o� alf. I ve read this
application and the information I have provided is correct. I have read th escr" on of Work and verify it is accurate. o com Ith all applicable local
ordinances and state laws relating to building construction. I a pre�e ives of Cupertino to enter the above-i perty for inspection purposes.
Signature of ApplicanUAgent: i' ( Date: 71 S
SUPPLEMENTAL AATION
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PVApp_2011.doc I-evised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20199 PACIFICA DR DATE' 06/09/2015 REVIEWED BY: MELISSA
APN: 369 29 011 BP#: 6 `VALUATION: $19,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Du lex _T_ PENTAMATION
USE: p PERMIT TYPE: SOLAR-RE A
WORK INSTALL 36 ROOF TOP FLUSH MOUNTED PV MODULES 9.36 kffl & INSTALL N 1.25 AMP SUB
SCOPE PANEL IN SIDE YARD (CORNER FROM MAIN) .
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ilea',. Plan('heck Plrru,h. flan Checr; Elec.Plan Check 0.0 hrs $0.00
A ;. Pe,•,uii fee.. Plunxh. Permit Fee: Elec.Permit Fee: 1EPERMIT
,'r:1-IrcFr. lnsp i),har, plumb nab lnsrz Other Elec.Insp. 0.0 hrs $48.00
,4£s'p. F,e. Plulub. Ins)). 1'ee: l.;leec.Insp. Fee.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $236.00 1PHOTOV12Es Photovoltaic System
PME Plan Check: $0.00125 amps Electrical
Permit Fee: $0.00 $48.00 IBELEC200 Services
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.00
C'ansil-uction Tax:
Administrative Fee: ]ADMAN $45.00 0
Work Without Permit? 0 Yes (2) No $0.00 E)
Advanced Planning.Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $2.47 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
"MOV
$144.47 $284.00 $428.47
Revised: 05/07/2015