B-2016-3321 Ij CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3321
20902 FARGO DR CUPERTINO,CA 95014-1806(326 30 115) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: ZIIANG KUN DATE ISSUED:12/22/2016
OWNER'S PHONE:650-759-8042 PHONE NO:(650)963-5100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#888104
Contractor SOLARCITY CORPORATION.Date 12/31/2018 X BLDG _ELECT PLUMB
_MECH X RESIDENTIAL_COMMERCIAL
Thereby 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. JOB DESCRIPTION:
INSTALL(13)ROOFTOP MOUNTED SOLAR PANELS(3.38)KW.
I hereby affirm under penalty of perjury one of the following two declarations:
i, 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.
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. Sq.Ft Floor Area: Valuation:$6000.00
APP.!.WANT 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 326 30 115
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 in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12.22.16 Issued by:SEAN HATCH
Date:12/22/20l 6
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the BE-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:12,22.16
I hereby affirm under penalty of perjury,one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
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 Mr 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,Sec 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: :
APP ICANT CERTIFICATION Date:12.22.16
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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature • Date 12.22.16 Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
AE
#.)9 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildincacupertino.orci
PROJECT ADDRESS
2-0 eft o 2. Ft -& , (NO.- APN S 34:9 /,15
OWNER NAMF,iict i 2. tt P110kEecic .cc3, MAI G22. 'L
e
4.3 c 46,1
STREET ADDRESS
c,96i Fracto Oa_ sr...E..kprix_to 47.42:7 I Le FAX
CONTACT NAME Gerry Igtanloc Pll0NE650-759-8042 E-MAIL gigtanloc@solarcity.com
STREET ADDRESS 391 Foster City Blvd. CITY,STATE,ZIP Foster City,CA,94404 FAX
0 OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME SolarCity Corp. LICENSE NUMBER 888104 LICENSE TYPE Cl 0,C46 BUS.LIC p28844
COMPANY NAME SolarCity Corp. E-MAIL gigtanloc@solarcity.com FAX
STREET ADDRESS 3055 Clearview Way CITY,STATE,ZIP San Mateo, CA 94402 PHONE 650-759-8042
ARCHITECT/ENGLNEER NAME LICENSE NUMBER BUS.LIC
COMPANY NA ME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 4FD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes i -No FLOOD ZONE 0 Yes No
P<LAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS': NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: (0 Q673
DESCRIPTION OF WORK
Install ( 13 ) rooftop mounted solar panels,(3 ,;y) KW
RECEIVED X'S'
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 it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b construction. I authorize representatives of Cupertino to enter the above-identified ptoperty for in1pection purposes.
Signature of Applicant/Agent: Date: 24q,c,
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
fr.4 ,YER-THE-CO UN TER,
b
EXPRESS
STANDARD
< LARGE
MAJOR
P VApp_2011.doc revised 03/16/11