15040128CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10106 CARMEN RD
CONTRACTOR: SOLARCITY
PERMIT NO: 15040128
OWNER'S NAME: CARL FARSAI
3055 CLEARVIEW WAY
DATE ISSUED: 04/22/2015
ON ER'S PHONE: 4088877837
SAN MATEO, CA 94402
PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
INSTALLATION OF ROOF MOUNTED SOLAR (22
License Class ic. N' ` (�
MODULES)(5.72 KW).
Contractor Date `1 S
I hereby of that I am licensed un er 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
Sq. Ft Floor Area:
Valuation: $13000
performance of the work for which this permit is issued.
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
APN Number: 35709065.00
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 OF PERNIIT 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 FRO ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may ac a against said City in consequence of the
ZZ
granting of this permit. Additio ly, th plicant understands and will comply
[ssDate:
with all non -point source regul ions p e Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date 66" 2 � 5
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 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
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)
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(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I usAequipmt evices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the ipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectionsnd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: elf&4&15
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I 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
1 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,
ARCHITECT'S DECLARATION
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
CUPERTINO
/5o y0 l3f
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 05014-3255
(408) 777-3228 • FAX (408) 777-3333 • building abcupertino.ora
AE
PROJECT ADDRESS .1 r I t, �i f ry) c-
„� I "
R—I •
l7i
APN il�� C/�O
OWNER NAME /'�
`?a 1
I NE
E-1`.7AIL
STREET ADDRESS y vy ti
IG1�a�Y�1C✓l �Z
CITY, STATE, ZIP t
CqrIJ
FAX
CONTACT NAME Marjan Javanmard
PHONE650.477.6430
&MAILmjavanmard@solarcity.com
STREETADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT ❑ CONTRACTOR 9 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGWEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME SolarCity Corporation
LICE NSENUivBER888104
LICENSE TYPE C10
BUS. LIC '28840
COMPANY NAMESOIarCity Corporation
E-MAIL rrljavanmard@solarcity.Corn
FAX
STREETADDRESS391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PH°"'E650.477.6430
ARCHTTECTfENGINEERNAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD Or Duplex ❑ Multi -Family
STRUCTURE El Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA El Yes F] No
PROJECT IN
FLOOD ZONE El Yes El No
si OLAR PANELS
❑ ELECTRIC VEHICLE CHARGNG STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OFPANELSMIITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION.
DESCRIPTION OF WORK
Installation (, ) rooftop flush mounted solar panel (5 IA) kW
RECEIVEDbY.
By my signature below, I certify to each of the following: I am the prop �r 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 pe ption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I author - r� ntatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of ApplicanUAgent: Date:
SUPPLEMENTAL NFORMATION REQUIRED
OFFICE USE oI` LY
OVER414 E -COUNTER
H'
W
U
'� E7CPRE"89
C STANDARD
C LARGE
a
11 MAJOR
PVApp_2011.docrevised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ImADDRESS: 10106 Carmen Road
DATE: 04/17/2015
REVIEWED BY: Sean
APN:
BP#: ``S Z�
"VALUATION: 1$13,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Alternative Energy System
IPHOTOVRES Photovoltaic System
PENTAMATION SOLAR -RE
PERMIT TYPE:
WORK
Installation of roof mounted solar 22 modules 5.72 k
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution II -053 Ef 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg.
Q OT
Fo,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i,�Jtt.'nIf l.Ir'iLfJtP 1 Lla,`:
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong Motion Fee:
IBSEISMICR
$1.69
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SI1I3T UL:
$2.69
$236.00
TUT'AL FEE;
$238.69
Revised: 04/01/2015
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