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15070090a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22028 LINDY IN CONTRACTOR: SOLARCITY PERMIT NO: 15080129 OWNER'S NAME: THOMAS TONY G AND MATHEW AN1JA TRUS 3055 CLEARVIEW WAY DATE ISSUED: 08/18/2015 O ER'S PHONE: 4085179793 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL 25 ROOF TOP, FLUSH MOUNTED PV MODULES 11 License Class (� ic., (6.5 �+- KW) Contractor Date I I S I hereby affir 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: 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: $14000 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: 35627007.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORIC4 NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITIiIN 180 �i + P + T 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 FRO D INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additio ly, t pplicant understands and will comply IssueDate: with all non -point source regul ons a the Cupertino Municipal Code, Section 9.18. p RE -ROOFS: Signature _— Date 0 _ All roofs shall be inspected prior to any roofing material being installed. If a roof is �I installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I 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). 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(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 Qpality Management District I performance of the work for which this permit is issued. will maintain compliance with the CupffoNkffficipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: 7 Date:. _ 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 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- RI! PILIDMr DIVIISlON ii}m TORRE AVENUE • CUPERTINO,. Off. 950f4-31,255. (408) 777-3228 - FAX (408) 7?'7-3.3,1ta = �uid�liirrn��„uur�Irmim®.ea,�� ��� �O(ZI PROJECT ADDRESS C� 0 p I I I r, APN # �? /'� 0 ,} --- ObVNERNruV1ETon �l�l- O w• � PHO _ I — q/4 E-MAIL STREET ADDRESS a n D�Xj CIS Y, STATE, IP0-4 S© CONTACTNAMEIVIarjan Javanmard PHONE 650.477,6430 E-MAILmjavanmard@solarcity.com STREETADDRESS391 Foster City Blvd CITY, STATE, "'Foster City, CA 944047FAX ❑ OWNER ❑ OW11MR-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ® COWRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME SOIarCity Corporation LICENSENUbBER 888104 LICENSE TYPE C1 0 BUS. LIC 028840 COMPANY NAMESOIarCity Corporation E-MAILnl.avanmard@solarcity.com FAX STREETADDRESS391 Foster City Blvd CITY, STATE, ZIP Foster City, CA 94404 PHONE650.477,6430 ARCHITECT/ENOrNEER NAME LICENSE NUMBER BUS. LIC # 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 FLOODZONE ❑ Yes ❑ NO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 9 C KILOWATTS (COMMERCIAL ONLY): / S • T TA1L/VALUATION- DESCRIPTION OF WORK Installation rooftop flush mounted solar panel kW By my signature below, I certify to each of the following: I t read e prop , owner or authorized agent to act on the p er's behalf. I have read this application and the information I have provided is correct. I i e ascription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I Ui representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: (9 � 0 15 SUPPLEIZFAF- AL tFORMATIO QUIRED �` G Icc,vs> ony - a `0', OVER -TRP -COUNTER P . STANDARD'-_ �' ' ❑, LABGE- iV]AJO13{ Mpp_2011.doc revised 03/16/11 CITY OF CUPERTINO FM'_] FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 22028 LINDY LN DATE: 08/18/2015 REVIEWED BY: MELISSA A11114. Perriif Fee APN: 356 27 007 BP#: *VALUATION: 1$14,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Plumb. hasp. Fee: PENTAMATION PERMIT TYPE: SOLAR -RE WORK INSTALL 25 ROOF TOP FLUSH MOUNTED PV MODULES 6.5 k SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eft. 7/1/13) Mech. Plan Check Plzuub. Plon Cheek Flec..Plan Check A11114. Perriif Fee Plumb. Permie Fee: Vlea Permit Fee: Ocher Heck lresp. Oilier Plumb Insp. Other Elec. lnsIV. Li 11ecla. hasp. bee: Plumb. hasp. Fee: lilec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eft. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1� # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.,00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(2) Reg. 0 OT F0.0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 i Trcrvel Doeumenlatiun Fees: Strong Motion Fee: IBSEISMICR $1.82 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 _ SUBTOTALS: 1 $2.82 $236.00 . TOTAL -,FEE: ° $238.82 Revised: 07/02/2015 I R LU ui pinz uj V co0 ¢ g °u �• � L) ' � � N L m W Q J W .�G tf7 o 4 a wU N O H� m S* a CREWi i w �. cp af y o I s cb r a� W Lu L n E' n� �¢* w p Q'.� W �'d�o°Loo N °acro C) D O p U f- :� U ^�- iL- a �O L➢t LJ e z r , _ a w _..�. O m J L M 1 co (DCD000CD W � .I N W O�w t%I� w d0 �- z.-`O o p v] 0=0 RE-) ®rn UJ N ON W U¢ti,j w} F = 0 O tt } O m Z w¢ �' K 7-{p� X S. 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