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B-2016-2846CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2846
23504 OAK VALLEY RD CUPERTINO, CA 95014-6555 (342 57 049) SOLARCITY
CORPORATION
SAN MATEO, CA 94402
I OWNER'S NAME: CHEUNG MAY I JDATE ISSUED: 10/03/2016 1
OWNER'S PHONE: 650-464-0909 I I PHONE NO: (650) 963-5100 I
111 Cal 51XI Of 1X40NIVITAT-4111111141up
License Class C-10: C-46: B Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2016
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:
t. 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
J r^`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
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 regulations Mr the Cupertino Municipal Code, Section 9.18.
Date 10/3/2016
hereby affirm that I am exempt from the Contractor's License Law for one of the
allowing 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 Cade)
2. 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:
1. 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.
i. 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.
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.
Date 10/3/2016
PERMIT INFO:
BLDG —ELECT PLUMB
MECH X RESIDENTTAL _ COMMERCIAL
3 DESCRIPTION:
27 -PANEL ROOF MOUNTED PV SYSTEM (7.16 KW)
Sq. Ft Floor Area; I Valuation: $14000.00
APN Number: Occupancy Type:
342 57 049
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: 10/03/2016
REROOFC
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 of Applicant:
Date: 10/3/2016
ALL ROOF
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(a) 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 , ctions 25 O5, 25533, and 25534.
Owner or authorized agent:
Date: 10/3/2016
CONSTRUCTION LENDING AGENCY
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
understand my plans shall be used as public records.
Licensed
�Low
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
PROJECT ADDRESS APN # '642-- ad t �1
`Z 0. G ft -CG v�ce`-(. P-4 v
OWNER NAME PHONE E-MAIL
F-
STREET ADDRESS CITY, STATE, ZIP FAX
CONTACT NAME Gerry Igtanloc PHONE 650-759-8042 E-MAIL gigtanloc@solarcity.com
STREET ADDRESS 391 Foster City Blvd. CITY, STATE; ZIP Foster City I
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IR CONTRACTOR ❑. CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME SolarCl Co LICENSE NUMBER 888104 LICENSE TYPE BUS. LIC#
ty rp C 10,C46 B `Z
COMPANY NAME SolarCity Corp. E-MAIL gigtanloc@solarcity.com FAX
STREET ADDRESS 3055 Clearview Way cITY, STATE, ZIP San Mateo, CA 94402 PHONE 6507759-8042
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC#
' COMPANY NAME
STREET ADDRESS
E-MAIL
CITY, STATE, ZIP
FAX
PHONE
USE OF IX SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: '❑ Commercial URBAN INTERFACE AREA ❑ Yes W. No FLOOD ZONE ❑ Yes. KI No
IR SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 7❑ SOLAR WATER HEATING ❑ OTHER:
FORSOLARPANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):TTTOTAL VALUATION:. .
DESCRIPTION OF WORK Install ( Z--) roof mounted solar panels. (`. 1S�)K VVt�T .
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 read this
application and the information I have provided 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 buq ing construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ► C<tj f 0
SUPPLEMENTAL INFORMATION REQUIRED
PVApp 2011.doc revised 03116/11
SMOKE / CAR80N MONOXIDE ALARMS j
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION+I
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiidhg&uuertino.or—g
Address 23504 Oak Valley Rd Cupertino, CA 95014 # of Alarms Smoke: � 1 Carbon Monoxide: a-
::.--; PE11Y:I'I' _C1