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09070161CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10210 STERN AVE CONTRACTOR: SOLARCITY PERMIT NO: 09070161 OWNER'S NAME: VIVI CHEN 393 VINTAGE PARK DR STE 140 DATE ISSUED: 07/23/2009 ! 'R'S PHONE: 4089967066 FOSTER CITY, CA 94404 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION r r— BUILDING PERMIT INFO: BLDG ELECT PLUMB ��License Class eel Q Lic. #/ e T r"" �Q� �Contractor o�C/ %z �� •Date MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL DEDICATED CIRCUIT FOR ELECTRIC (commencing with Section 7000) of Division 3 of the Business & Professions VEHICLE Code and that my license is in full force and effect. CHARGER (GFI PROTECTED) 1 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $1500 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. APN Number: 37512001.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally, the applicant understands and will comply with all non- ource regulations per the Cupertino Municipal Code, Section Issued by.. Signature Date J OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I use equipment or devices which emit hazardous air permit is issued. 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 I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. 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 Dw rr�e fr authori �a n / become subject to the Worker's Compensation provisions of the Labor Code, I must Date: forthwith comply comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is 'or which this permit is issued (Sec. 3097, Civ C.) correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address in(' Ty and keep harmless the City of Cupertino against liabilities, judgments, cc id expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blki: Lot: APN ........: 37E12001.00 DATE ISSUED.......: 07/23/2009 RECEIPT #.........: BSC00008257 REFERENCE ID # ...: 09C70161 SITE ADDRESS .....: 1010 STERN AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. VIVI CHEN ADDRESS ..........: 10210 STERN AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ERIK ROTH CONTRACTOR .......: LYNDON RIVE LIC # 28844 COMPANY ..........: SOIARCITY ADDRESS ..........: 39: VINTAGE PARK DR STE 140 CITY/STATE/ZIP ...: FOSTER CITY, CA 94404 TELEPHONE ........: (6E,0) 638-1028 FEE ID UNIT QUANTITY 1,MOUNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 1,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BREMRECEP NO. OUTLETS 1.00 42.00 0.00 42.00 0.00 1BSEISMICR VALUATION 1,500.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 ---------- TOTAL PERMIT ---------- 127.50 ---------- 0.00 ---------- 127.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD 127.50 -------------------- VISA --------------- TOTAL RECEIPT 127.50 CLIP !<kyIN0 CITY OF (:UPERTINO GENERAI. BUILDING PERMIT APPLICATION FORM 0 9 eD,, � 110t�, I APN # 3-7 f5 1 t v 0 Date: Building Address: 2-/ C) 5T mac.,` cAt 'A Mailing Address (if different from building address): Are Hazardous Materials being used as part of thi, project? Yes No HOA: Exterior work only) Yes ❑ No If des, provide letter from HOA Owner's Name: ��� % Phone #: Contractor: Phone: S ax: - / — Contractor License #: 'U L/ Cupertino Business License #: Contact: I( l�Cf Phone: 71—�— Fax: Residential g Commercial Job Description: 17 1 v� Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: l -A, 1-13 II/Ill/V-A IUIII B, IV -HT, V -B F] C• /V ° C-67- i Valuation: d/� � Square Footage: /X Project Size: Express& ExpressStandard Large Major EJ Greven Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at srwAy.builditai-eL�.t�i'� Revised 07/14/09 1), CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additiona: stucco application B 1 WINREP Replacers. ent windows/sliding glass door (ea 3 windows) B 1 WINMEWSTR New Window -structural shear wall/mast, (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P l ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic F:esidential B 1BSEISMICO Seismic Commercial B / ( 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 Tesla electrical service evaluation form NEC 220.83 - add a circuit to an existing dwelling unit Customer name: Vivi Chen © copyright SolarCity 2008 Property address: 10210 Stern Ave Cupertino, CA 95014 Square Feet: 4100 Main service: 200 ams line/line volts: 240 NEC 220.83(A)(1) "General lighting and genera use receptacles ... @ 3 volt/amperes per square foot as determined by 220.12" 4100 square feet x 3w/:q ft 12300 VA NEC 220.83(A)(2) small appliance and IE undry branch circuits @1500VA per 20 amp circuit JAC equipment unit #2 total number of circuits: 5 x 1500= 7500 VA NEC 220.83(A)(3) "Household Range(s), wall-nounted oven(s), and counter -mounted cooking unit(s)" total proposed calculated load: oven 6240 VA warming drawer 0 VA oven#2 0 VA microwave 1560 VA 7800 total VA NEC 220.83(A)(4) "All other appliances that are permanently connected, fastened in place, or connected to a delicated circuit, at nameplate rating" disposer 560 VA dishwasher 2208 VA bar fridge 0 VA Thermador fridge/freezer 1320 VA wine fridge 360 VA Jacuzzi Bath 5280 VA Dryer 5760 VA Washer 2160 VA kitchen downdraft hood 660 VA Tesla Electric Vehicle Chariier 16800 VA 35108 total VA total of non air-conditioning loads: 62708 total VA first 8kVA of load at 100% 8000 VA remainder of load at 40% 21883.2 VA total non air-conditioning load 29883.2 VA NEC 220.83(B) "Where additional air-conditioning equipment or electric space -heating equipment is to be installed..." AC equipment unit #1 total 8976 VA JAC equipment unit #2 total 0 VA total of air conditiong load and all other loads: 38859.2 total VA total proposed calculated load: 161.91333 Amps Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 .;UPEI�TINO Building Department JOB ADDRESS: / 60L r o S c�• 'tPERMIT # OWNER'S NAME: /I// PHONE # — �P?G a d� GENERAL CONTRACTOR: - FAX # I am not using any subcontractors: �T Si;,nature Date Please check annlicable subcontractors and comi)lete the followinz information: a2- Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical c Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile a2- Owner/Contractor Signature Date