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14100111-VOIDa CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 802 ALDERBROOK LN CONTRACTOR: SOLARCITY PERMIT NO: 14100111 OWNER'S NAME: MUDRADI RAMESH K AND SRIKANTAN RUPA 3055 CLEARVIEW WAY DATE ISSUED: 10/20/2014 OWNER'S PHONE: 4082453416 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] INSTALL 9 ROOF TOP, FLUSH MOUNTED PV PANELS (2.34 tJ License Class ic. # D g —1 KW) Contractor Date ((� Q_D�1� I hereby a r ►at I am licensed t _provisions of Chapter 9 (comme ' g 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: $4500 performance of the work for which this permit is issued. 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 APN Number: 36917029.00 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 PERMIT 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 FR D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, andexpenses which acc gainst said City in consequence of the `L granting of this permit. d' lona y the applicant understands and will comply I b with all non -point sourc r ulat' per the Cupertino Municipal Code, Section 9.18. Signature Date I 0 /' RE -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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 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 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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(a) 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 equipm t 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 A96aAir Q lity Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupeoi96 Mugicy0al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 553 , d 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 per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ` (408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org \�/� PROJECTADDRESS802 ALDERBROOK LN. APN# 3(o q - / 7 - p OWNERNAMEMUDRADI, RAMESH PHGNE408-245-3416 &MAIL I STREETADDRESS802 ALDERBROOK LN. CITY, STATE, ZIP CUPERTINO,CA 95014 FAX CONTACT NAME Marjan Javanmard PHONE 650.477.6430 E-MAIL mjavanmard@solarcity.com STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER-BUB.DER ❑ OWNER AGENT ❑ CONTRACTOR M CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME SolarCity Corporation LICENSE NUMBER 888104 LICENSE TYPE C10 BUS. LIC 428840 COMPANY NAME SolarCity Corporation E-MAIL mjavanmard@solarcity.com FAX STREETADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE 650.477.6430 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family ST UCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes O PROJECT IN FLOOD ZONE ❑ Yes ❑ NO Ii _T SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 1 ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OFP NELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: `.FA,500.00 DESCRIPTION OF WORK Installation (9) rooftop flush mounted solar panel (2.34) kW RECEI V By my signature below, I certify to each of the following: I the erty owner or authorized agent to act on the property owner' I have read this application and the information I have provided is correct. ave r a the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building const I r e ze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: L - SUPPLE AL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER a F' v; ❑ EXPRESS U S ❑ STANDARD U 7_ a ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03116/11 CITY OF CUPERTINO Iii I FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef' 711113) ADDRESS: 802 ALDERBROOK LN DATE: 10/20/2014 REVIEWED BY: MELISSA 1 APN: 36917 029 BP#: �� `VALUATION: 1$4,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION SOLAR -RE PERMIT TYPE: WORK INSTALL 9 ROOF TOP, FLUSH MOUNTED PV PANELS (2.34 k1/� SCOPE -- - -- -- - - NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef' 711113) FEE QTY/FEE I; ect 1 71111 $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System 1PHOTOVRES Photovoltaic System Suppl. PC Fee: ) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 --r-T O G) Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G) i ! Tk>cr.��mrFzl,ztinrt Fees_ Strong Motion Fee: IBSEISMICR $0.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.59 $236.00 TOTAL FEE: $237.59 Revised: 08/20/2014 ="�SolarCity May 12, 2015 Dear Sir or Madam: This letter is to inquire about cancelling the permit for the following customer: Ramesh Mudradi 802 Alderbrook Ln. Cupertino, CA 94462 Permit # 14100111 The customer has decided to cancel their solar project with SolarCity. We hereby request a refund of fees, If possible. Refund checks can be mailed directly to the following address: ATTN: Cassandra Chaves SolarCity Las Vegas 6671 Las Vegas Blvd S STE 300 Las Vegas, NV 89119-3290 If you have any questions or need anything further, please let me know. Sincerely, Marjan Javanmard, Permit Coordinator (650)477-6430 miavanmard(cD-solarcity.com 3055 Clearview Way San Mateo, CA 94402 T (650) 638-1028 (888) SOL -CITY F (650) 638-1029 SOLARCITY.COM AZ ROC 243771. CA CSLB 888104, CO EC 8041, OR CCR 180498, TX TDLR 2700E