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15060148CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 968 NOVEMBER DR CONTRACTOR: SOLARCITY PERMIT NO: 15060148 OWNER'S NAME: RAMPI RAMBRASAD 3055 CLEARVIEW WAY DATE ISSUED: 06/23/2015 OW ER'S PHONE: 4083136319 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REVISED SCOPE OF WORK - INSTALL 17 PV MODELUES License Class I C7 Lic. # X $ l7 AT ( r Contractor .7 l C t i ` / Date O T (t, I -, 4.42KW - 7/16/15 1( / / 1 hereby affirm that I am license 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. 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 Sq. Ft Floor Area: Valuation: $14500 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: 36213026.00 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 vnproperty for purposes. esave p AS L I N. indemnify and keep harmless the City of Cupertino ino agamst liabilities,judemenu d _.. _ 1P ^"T" costs,anxpeneswhich m accrue agmstsad City inconsequence of the A�L,. granting of this permit. Ad"ona},I� the applicant understands and will complyjued by: ate: with all non-point source r latib s per the Cupertino Municipal Code, Section w 9.18. t i� RE-ROOFS: Signature Date I 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: [ 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cu ti M 'cipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550 S�nd 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 l 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 i CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION 00iMMUNJ ( DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3.'15�� jgffoc))�s (408) 777-3228 • FAX (408;777-35:3 • buildingaal-cupertino.or PROJECT ADDRESS A }�y.,y , J i� 4'V� �,• V V t APN N . � I . OWNER NAMEl „„�� PHONE a , � ut C� C CU E-MAIL STREET ADDRESS I /" " q CITY, STATE, IP �% U [� g' r U wl Y L T 1 �`i V t\0 S C I FAX CONTACT NAME Marjan Javanmard PHONE650.477.6430 E-IIA`Lmjavanmard@solarcity.com STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR M CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESOIarCity Corporation 1ECENSENUMBER888104 LICENSE TYPEC10 BUS .UCk28840 COMPANY NAMESOIarCity Corporation E-MA`Lmjavanmard@solarcity.com FAX STREETADDRESs391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477.6430 ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-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 FLOOD ZONE ❑ Yes ❑ NO I OLAR PANELS ❑ ELECTRIC VEHICLE CHA,-RyGI`NG STATION TO SOLAR WATER HEATING FOR SOLAR PANELS: NUMBER OF PAS 1ELS(UNITS: i" KILOWATTS (COMMERCIAL ONLY): „+ ,/ t i) ❑ OTHER: TOTAL VALUATION DESCRIPTION S � P L 1 "J , Installation (_Ll_) rooftop flush mounted solar panel ( kW By my signature below, I certify to each of the following: I a e pr erty owner or authorized agent to act e property owner�,�etaalf J have read this application and the information I have provided is cotTect I e rea` he Description of Work and verify it is accurate. [ agree to comply with all applicable local ordinances and state laws relating to building constntction. at ho ` e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ` Date: SUPPLENr,NTA INFORMATION REQUIRED OFFICE USE ONLY ER -TF E -COUNTER ❑ PXPRESS y� ❑ STANDARD U Z ❑ LARGE a ❑ MAJOR PVApp_201 I. doc revised 0311611 CITY OF CUPERTINO Iwo FEE ESTIMATOR - BUILDING DIVISION igADDRESS: 968 NOVEMBER DR DATE: 07/16/2015 APN: 36213 026 BP#: 15060148 REVIEWED BY: MELISSA 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 1 hours Plan Check, Hourly $143.00 ISTPLNCK PENTAMATION PERMIT TYPE: 1 GENRE WORK REVISED SCOPE OF WORK - INSTALL 17 PV MODELUES AT 4.42KW - 7/16/15 SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Mctrirl otr 1 Thoco fooc aro hacod nn tho nroliminan) in/armatinn availahlo and aro nnly nn octimalo_ Cnttlarl tho Dont fir addn'1 hila_ FEE ITEMS (Fee Resolulion II -053 ETf 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SuppL Insp. Fee:Q Reg. © OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ?rnratirr rrti i'cc. 0 E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 i i"rrt %�('4 1)oc oln'rnhaioo /"O'S. Strong, Motion Fee: $0.00 Select an Administrative Item Bldg; Stds Commission Fee: $0.00 $TBTfYTALa:1" $0.00 $143.001 TC TAI $143.00 Revised: 07/02/2015 CU.PERTINO WATER -CONSERVING PLUMBING FIXTURES �� OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � "" (408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org O� j (2 Owner Name ,r� ""�"1'? �'� -A- K��.NI) A s)A l Permit No. Ty . Address 9.6 3 L(2-. cx((-Tr"na1�4- Please refer to the attached California Civil Code Sections 1101.1 — 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: r _ l Date: 0 1 1 1 2o,�_ El"'No Go to Question 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form Owner' Signature: 19/No Go to Question 3. Date: o311 I I 161 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: \ZNo Go to Question 4. Date: 0 ]I l° `moi 5 Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: ' A 1C)�j Date: 6'/ j1q jt1olj 'F Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. .71"My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or irnprovements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or irnprovements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or irnprovements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2015. doe revised 02/04/15 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). UWe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbin tures comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: 0-1 t') i 2., Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015. doe revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015. doe revised 02/04/15 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ` (408) 777-3228 •FAX (408) 777-3333 • building (c)cupertino.org ry Permit No.�/�/y��J/`J� Address �6 r � t ��# of Alarms Smoke: L+ Carbon Monoxide: i PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X _ X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: 1Ji y !1v Y A_ -'�'�". AtN Signature ......................................................................................... Date: .. I\`� � Contractor Name: Signature........................................ ........................... Lic.#...................................... Date: ................... Smoke and CO form doc revised 03118114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 968 NOVEMBER DR CONTRACTOR: SOLARCITY PERMIT NO: 15060148 OWNER'S NAME: RAMPI RAMBRASAD 3055 CLEARVIEW WAY DATE ISSUED: 06/23/2015 OWNER'S PHONE: 4083136319 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ SOLAR ROOFTOP MOUNTED - 25 MODULES (6.5KW) p [� License Class CJ) Q-0 Lic. # p ZS � (� I/ r� Contractor Lem i i Date ro (S I hereby affirm that I am license under the provisions of Chapter 9 (commencing with Sectio 000) of Division 3 of the Business & Professions Code and that my license is i ull force and effect. 1 hereby affirm under penalty o rjury one of the following two declarations: I have and will maintain a certificate consent to self -insure for Worker's Compensation, as provided for by Secti 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $14500 performance of the work for which this pe it is issued. 1 have and will maintain Worker's Compens on Insurance, as provided for by Section 3700 of the Labor Code, for the perfor nce of the work for which this APN Number: 36213026. Occupancy Type: permit is issued. APPLICANT CERTIFI TION I certify that I have read this application and state tha a above information is XPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordi ces and state laws relating 0 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representa es of this city to enter upon the above mentioned property for inspection purpose (We) agree to save /18AYSROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against li ilities,judgments, costs, and expenses which may ccrue against said City in con quence of the IsDate: granting of this permit. Additi ally, a applicant understands d will comply with all non -point source reg tion er the Cupertino Municipal ide, Section 9.18. y 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License La or one 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 sol ompensation, will do the work, and the structure is not intended or offered for sa (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with li nsed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Co 1 have re the hazardous materials requirements under Chapter 6.95 of the California ealth & Safety Code, Sections 25505, 25533, and 25534. I will 1 hereby affirm under penalty of perjury one of the f owing three maintain co liance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safe Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to f -insure for Worker's material. Additi ally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of e Labor Code, for the air contaminants defined by the Bay Are Air ality Management District I performance of the work for which this permit i ssued. will maintain comp) nce with the Cuperti' M ipal Code, Chapter 9.12 and I have and will maintain Worker's Compensat n Insurance, as provided for by Section 3700 of the Labor Code, for the perf ance of the work for which this the Health &Safety de, Sections 25505 X53 and 25534. r J Owner or authorized age t: Date:lQ permit is issued. I certify that in the performance of the w k for which this permit is issued, I shall not employ any person in any manner as to become subject to the Worker's Compensation laws of California. If, fter making this certificate of exemption, 1 CONST CTION LENDING AGENCY become subject to the Worker's Co pensation provisions of the Labor Code, I must I hereby affirm that there is a cons ction lending agency for the performance of forthwith comply with such provis ns or this permit shall be deemed revoked, work's for which this permit is issu (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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 CITY OF CUPERTINO 4g rm-N FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 968 NOVEMBER DRIVE DATE: 06/23/2015 REVIEWED BY: PAUL MMMM MW APN: 362 13 026 BP#: 'VALUATION: $14,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or DuplexT USE: Suppl. PC Fee: 0 Reg. Q OT PENTAMATION SOLAR -RES PERMIT TYPE: WORK Solar Rooftop Mounted - 25 Modules 6.5K SCOPE NOTE: This estimate does not include fees due to other Departments (Le. 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 Deptfor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS MMMM MW N MM $0.00 # $236.00 Alternative Energy System IPHOTOVRES I Photovoltaic System Suppl. PC Fee: 0 Reg. Q OT NOTE: This estimate does not include fees due to other Departments (Le. 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 Deptfor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $236.00 Alternative Energy System IPHOTOVRES I Photovoltaic System Suppl. PC Fee: 0 Reg. Q OT FO.01 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 ( F�r�sr'fIr<�rt IGt:e: �irt.rt�� rr,a�r rr arcs. Q (F) Work Without Permit? Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q 0 Onur"H :Frr,,r for I� 1 ce:,. Strong Motion Fee: IBSEISMICR $1.89 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 S[1BT©YACs, $2.89 $236.00 TOT'A..L FER $238.89 Revised: 05/07/2015 CU'PE 2TINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BULUNG UVISION 110300 TORRE AVENUE • CUPERTINO, CA 95014-3€55 15(yoc) I 8 A E;408) 777-3228 • FAX (408) 77 7-3333 • �u k Ru'LagLq utin(j.�a PROJECT ADDRESS NO�/�n�bcr or, APN N °� 3n�� ObVNER NAMEd + r+� rr7 5 a 1�/ v01'1 4Ct_C CA_j PHONE _ 6— 2, f E-NIAIL STREET ADDRESS CITY, STATE, IP _ FAX CONTACT NAME Marjan Javanmard PHONE 650.477.6430 E-MAIL mjavanmard@solarcity.com STREETADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWN'ER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCFIITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESOIarCity Corporation LICE NSENUNIBER888104 LICENSE TYPE C10 BUS. LIC '28840 COMPANY NAME SolarCity Corporation E-NIAIL mjavanmard@solarcity. com FAX STREET ADDRESS 391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477.6430 ARCI-IITECC/ENGMEER NAME LICENSE NUMBER BUS. LIC H COMPANY NAME E-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 R,1 FLOOD ZONE ❑ Yes ❑ NO RSOLA.R PANELS —T ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS, NUMBEROFPANELS/UNITS: p�-S KILOWATTS (COMMERCIAL ONLY): 6.5 TOTALVALUATION 1 DESCRIPTION OF WORK Installation (�5) rooftop flush mounted solar panel (S) kW RECEIVED BY By my signature below, I certify to each of the following: I am e pr erty owner or authorized agent to act on the prope owner's behalf. I have read this application and the information I have provided is correct. I h e re d he Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. a tho e representatives of Cupertino to enter the above- identified property for inspection purposes. Signature ofApp] icanh'Agent Date: li a SUPPLE N INFORMATION REQUIRED OFFJCEUSE ONLY OVER-TIj R-C:OCNTER l� FXPIRESS U El STANDARD U z LARGE.. a MAJOR. PVApp_2011.doc revised 03/16/11 f 4, • I RE: Intertek (ETL) Field Listings for Supply Side Connections TO: Building Officials, Plan Checkers & Inspectors Dear Sir or Madam, us (413T)SO SolarCity has partnered with Intertek (ETL) the Nationally Recognized Testing Laboratory and Listing Agency. Engineers from Intertek will be performing a Field Listing of a supply side connection in your jurisdiction for a residential solar system. Intertek will recertify the existing equipment, confirm that it is NEC compliant, and safe for use. After Intertek has verified -the installation, their engineer will apply the ETL Field Listing sticker to the main electric panel, (see sample below). Upon completion Intertek will send a report to your jurisdiction and to SolarCity. Should you have any questions, please feel free to contact the Intertek or SolarCity representatives listed below. Thank you for your time and consideration on this project. We look forward to working with you. Neelesh Thakkar Senior Project Engineer Intertek (ETL) (503) 676 2317 neelesh.thakkar@intertek.com Kyle Breuning Engineering Quality & Standards Manager (650) 963-5100 x 5803 kbreuning ja.solarcity.com Duncan Cleminshaw Code Compliance Manager (415) 329-0751 dcleminshaw(cD_solarcity.com 'rw< . � (' 9.1 3055 Clearview/ Way San Mateo, CA 94402 T (650) 638-1028 (888) SOL -CITY F (650) 638-1029 SOLARCITY.COM AZ ROC 243771, C.4 CS L9 399 Lii 4, CO EC 804 L OR CC2 t80498, TA TDLR 27006 I o 4 Ili WE 75 Ln 1 a =z w Uj N. 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