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15090072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR:SOLARCITY PERMIT NO: 15090072 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARAJ SUSHM 3055 CLEARVIEW WAY DATE ISSUED:09/11/2015 OWNER'S PHONE: 3108490146 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL INSTALL 26 ROOF TOP,FLUSH MOUNTED PV MODULES License Class Lic.# E f 1 O L1 (5.33 KW) Contractor �# a ✓lJ 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: Sq.Ft Floor Area: Valuation:$11000 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 APN Number:32608028.00 Occupancy Type: performance of the work for which this permit is issued. 2. 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 permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DA ISSUANCE OR I certify that 1 have read this application and state that the above information is 180 D INSPE TIO correct.I agree to comply with all city and county ordinances and state laws relatin to building construction,and hereby authorize representatives of this city to // upon the above mentioned property for inspection purposes. (We)agree to save Iss Date: indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may ague a ' st said City in consequence of the - granting of this permit. Addition' ly, applicant understands and will comply with RE-ROOFS all non-point source regulation pe a Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date : installed without first obtaining an inspection,I agree to remove all new materials for z inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: - t. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. i,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air t. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation,as provided for by'Section 3700 of the Labor Code,for the maintain compliance h th Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Coo' Sec /s 25505,25533,and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for b P p Y Owner or author' ed'a nit• Section 3700 of the Labor Code,for the performance of the work for which this Date: permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY 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 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.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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 4 ALTERNATIVE ENERGY PERMIT APPLICATION �..4v;T:Ys9.v?, , # .`,'~__'PJ E-_NT D-EP"'A MENT-��L:°LDVN ^I N r -CUPRWNOCA f WPE _ ' .� � R JC2ku! PROJECT ADDRESS g �(1 Ji, F MI o OWNER NAME PHONE E-MAIL LC STREETADDRESS y Z Q STATE,ZIP `f FAX rg _ C 1 J tea I i CONTACT NAME Mar an Javanmard PHUNE E-MAIL J $ City 650.47.7.6430 mjavanmard@solarcity.com STREETADDRESs391 Foster laity Blvd CITY,STATE,ZIP Foster City, CA 944041 FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ®CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMEBolarCity CorporationLICENSINUMBER 888104 LICENSE TYPE C10 BUS.LICF28840 COMPANYNAMEBolarCity Corporation E-MAILmjav®®atnmard@solarcilyFI CCJJUU��tt.,com STREETADDRESS391 Foster City Blvd CITY,STATE,ZIP Foster City, CA 94404 PHONE650.477.6430 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NANIE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE f USE OF r2f SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO ®SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER DATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UMTS: P KILOWATTS(COMMERCIAL ONLY): " TOTAL VALUATIO DESCRIPTION OF WORK Installation j rooftop flush mounted solar panel ( ? kW DB By my signature below,I certify to each of the following: I am th'prope• owner or authorized agent to act on the pro vner's behal e read this application and the information I have provided is correct. I hav Vad th escription ofWork and verify it is accupats.7 I agree to coAij<with all applicable local ordinances and state laws relating to building construction. I thorn ep as tatives of Cupertino to enter the above-ide ti operiy for inspection purposes. Signature of Applicant/Agent: ` Date: SUPPLE INFORMATION-REQUIRED OFFICE USE ONLY �1 O , WWTHE-COUNTER E H ❑ ESPRESS V ❑ STANDARD V MAJOR PJIAPP ZOII,.4ocrwsNdW110 --- --- CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10585 FLORA VISTA AVE DATE: 09/11/2015 REVIEWED BY: MELISSA APN: 326 08 028 BP#: 7!�7 VALUATION: 1$11,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION SFD or Duplex SOLAR-RES USE: PERMIT TYPE: i WORK INSTALL 26 ROOF TOP FLUSH MOUNTED PV MODULES 5.33'k SCOPE A kc:h. Plum L'heek llhwib.Plata Cheeik 1aec..Pkm(..'hecic �9eclt. Per•zrait Fire: Plumb. Permit Fee: Ale.c. Permit Fe C}�7c r i7cc lr. lrrst3. Ll I fltlic, f'ircnrlt Insp. Offer 1,'ec_Im.p. i-Each.Ira.rp_ Fee:: Phinib. Irrsp. Fee: f<lec.Ins,.:Fee: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $236.001-IPHOTOvxEs Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee: Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �.,E112:.r't1'2,tClif)f2 Tax: Work Without Permit? 0 Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential ,... Building or Structure I r^u�'e'Z T�tJL'trrrGetattttrt;ri'f`e'es: Strong Motion Fee: IBSEISMICR $1.43 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTAI3Sr $2.43 $236.00 T© Aif F- Etp $238.43 Revised: 07/02/2015