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14010023CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; 10305 VIRGINIA SWAN PL CONTRACTOR: SOLARCITY PERMIT NO: 14010023 OWNER'S NAME: GILLETTE LYNN H AND JOLENE G T 3055 CLF,ARVIEW WAY DATE ISSUED: 01/06/2014 OWNER'S PHONE: 4089962864 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ® COMMERCIAL � ( License Class 4 y;�w_ Lic.# N 1 INSTALL 8 ROOFTOP, FLUSH MOUNTED PV PANELS (2KW) & ADD 125AMP SUB PANEL Contractor Date I hereby affirm that I am licenseQ under the provisions of Chapter 9 (commencing with Section 7004) 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: $8000 erformance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31646013.00 Occupancy Type: 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 PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (Vere) agree to save 180 DAYS ALLED INSPECTION. 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 a Date; with all non -point source regulatigns per the Cupertino Municipal Code, S 9.18. �r RE -ROOFS: Signature ( Date 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. 13 OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirmn 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 (See.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 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Se i 25505, 2553 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this { Owner or authorized agent:. Date: { permit is issued. 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 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 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, 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 perthe Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date AM ALTERNATIVE ENERGY PERMIT APPLICATION elz COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 A (408) 777-3228 - FAX (408) 777-3333 - buildingacuperting.org PROJECT ADDRESS AA"' 5t J 'f 6 0 (3 E-MAITs e- I C iF C&O IL STREET ADDRESS 3o V1 15- Atl't L/ CITY 4TAT 9'ZIP FAX C N COTACT NAME V� 0 S\ PHO 5D) &q31 I E-MAIL STREET ADDRESS C CITM. ZIP qj FAX El OWNER 13 OWNER.BUILDER 171 OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT 171 ENGINEER 171 DEVELOPER M TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE -96 BUS. LIC 9 COMPANY NAME �9o�af E-MAIL ss cow, FAX STREET ADDRESS( CITY, STATE, ZIP Cj PHO Nff, ARCHITECTIENGINEER NAME LICENSE NUMBER BUS, LIC' , COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF D4,SFD or Duplex C3 Multi -Family PROJECT IN WILDLAND STRUCTURE, (3 Commercial URBAN INTERFACE AREA El Yes 171 No PROJECT IN FLOOD ZONE C3. Yes E3 No �(GLAR PANELS 13 ELECTRIC VEHICLE CHARGING STATION 1 11 SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANE) 9. NUMBER OF PANELS/UNITS: k KILOWATT& f ?� TOTALVALUATION. Do Q DESCRIPTION OF WORK MA)3 0 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propertyceu_��[ 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 tfbuilding constructicf\ 1 authorize representatives of Cupertino to enter the / above -identified rty for inspection purposes. pr Signature ofApplicant/A Date: Iq SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY WOVER-THE-COUNTER EXPRESS U STANDARD LARGE MAJOR PVApp.2012.doc revised 06120/12 ca& f- hffl'� �-) - ta'f' CITY OF CUPERTINO "VV'V V4ZTFTrAT,*V, — V.IT1I,1)1VV_ 411VIR1*11 A4 DATE: 01/06/2014 QTYIFEE APN: 316 46 013 1 Plan Check Fee: $0.00 1 # $229.00 *PERMIT TYPE: Building Permit Suppl. PC Fee: (E) Reg. 0 OT PRIMARY SFD or Duplex hrs $0.00 USE: $0.00E-125] amps $47.00 Electrical IBELEC 00 Services INSTALL 8 ROOFTOP, FLUSH MOUNTED PV PANELS (2kW) & ADD 125AMP SUB PANEL $0.00 ----- 0,4 A.OI e,�h, Plan Check [_kkch, Pernfil Fee: Other,;Vech. Insp, A,1'��ch, IiISJO Phimb, Pfa,i ("heck I I I711UMb, Permit Fee 0j;jCr Pj�,"Mb &M, {'Tuna 'j, Elec. Plan Check 10.0 1 hrs $0.00 1 Elec. Permit Fee: IEPERA11T Other Elec. Insp. 0.0 hrs NOTE. This estimate does not inctuaejees aue to orner veparitments ye.,rtanning, z-uvitc; rr ulna} 9 'y ",Tall 1, ct!= +.-----_..-• FEE ITEMS 9,Lee Resolution 11-053 E _711-1-1-3} FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 1 # $229.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: (E) Reg. 0 OT —0.0 hrs $0.00 PME Plan Check: $0.00E-125] amps $47.00 Electrical IBELEC 00 Services Permit Fee: $0.00 Suppl. Insp. Fee -Q) Reg. 0 OT 0,4 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Consowetion TcLv: T-1 Administrative Fee: JADMIN $44.00 0 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel Documentation Fee: IMVDOC $47.00 Strong Motion Fee: IBSEISMCR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 U0 'T' $139.6 F U $415.80 Revised: 10/01/2013 �1 c dm uj AL S CL r r ' tk 0 L fj i4S N W �• .y5 �j.. 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