B-2017-1125CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1125
7733 RAINBOW DR CUPERTINO, CA 95014-5268 (362 24 017) SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: DEEDUVANU SRINIVAS K C AND SRINIVASDEEDUVAN
OWNER'S PHONE: 650-759-8042
LICENSED CONTRACTOR'S DECLARATION
License Class C-10: C-46 Lic. #$B$i24
Contractor SOLARCITY CORPORATION Date 12/31/2018
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:
r. I have and will maintain a certificate of consent to self -insure for Worker's
pIompensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
J\ Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT 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
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, 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 regulati r,'; er the Cupertino Municipal Code, Section 9.18.
Signature il Date 7/13/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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.
z. 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.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT 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 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, 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 7/13/2017
DATE ISSUED: 07/13/2017
PHONE NO: (650) 963-5100
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
14 -PANEL ROOF MOUNTED PV SYSTEM (4.2 KW)
f (S vw Lis OLVVV05
Sq. Ft Floor Area: I Valuation: $15000.00
APN Number: Occupancy Type:
362 24 017
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 07/13/2017
RF ROOFS:
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.
Signature ofApl
Date: 7/13/2017
ALL ROOF
"A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code tions 25505, 25533, and 25534.
1�p
Owner or authorized agent: Z -
Date: 7/13/2017
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 950143255
(408) 777-3228 - FAX (408) 777-3333 - v=uldra,^ouoertno.oro r
PROJECT ADDRESS?- �l Al }i 0 UJ r%
APN N
OwNERNAME 5r/ V9
PHONE (fOSQ—
�
E-MAM'5 p- 6
STREET ADDRESS ;3 Q (_ � J r /� `
Vc
:)-_/C_83
CITY, SCv Z[I LveTr'f 0 ^ A, f g(o
/�gigtanloc@solarcity.COM'
�^l
FAX
CONTACT NAME Gerry Igtanloc
PHONE650-7/5f 9-80424
�
STREETADDREss391 Foster City Blvd.
CTM STATE, ZIP Foster City,CA,944041
FAX
❑ Owm ❑ OwNER-B=ER ❑ OwNERAGENT 0 CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
-T
CONTRACTORNAMESOIarClty Corp.
LICENSE 88104
LICENSETYPEC10,�6
Bus.LTcx28844
COMPANYNAMESolarCity Corp.
EMAIL L��++vv
sTREETADDREss3055 Clearview Way
CITY. STATE, ZIP San Mateo, CA 94402
PHONE650-759-8042
ARCHTTECTIENGINEER NAME
LICENSE NUMBER
r
BUS. LTC #
COMPANY NAME
&MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOGD ZONE ❑ Yes ❑ No
SOLAR PANELS
1 ❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER BEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: / S O ^
,
[ lJ
DESCRIPTION OF WORK
Install (j ) rooftop mounted solar panels,(-{ Z) KW
" ,P-w-
Oiv1n
A ,' /
RWE. VED BY- (Abu—
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 nd't`(bi/iq
By
application and the information I have provied 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 uilding construction a -u Iorize representatives of Cupertino to enter the above-* entif777roperty for inspection purposes.
Signature of Applicant/Agent. 4� Date: % 3
tUPPLEMENTAL INFORMATION REQUIRED
, OM& 1JSE OICY ..
W
zUz
a
w
❑ 'OVER-THE-COUNTER
❑ .PRESS
STA:HDARI)
❑ LARGE
MAJOR
PVAnn 701I:dnc rovicad n?/16/11
it—