B-2017-0549CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0549
10440 SERRA ST CUPERTINO, CA 95014-6581(342 59 014)
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
OWNER'S NAME: GILLEY MICHAEL AND SAKARAAPRIL A TRUSTEE
DATE ISSUED: 04/05/2017
OWNER'S PHONE: 408-858-5757
PHONE NO: (650) 963-5100
LICENSED CONIRACTORIS DECLARATION
BUILDING PERMIT INFO:
License Class C -10:C-463 Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
X_ BLDG X ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH X RESIDENTLAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:
INSTALL BATTERY BACK UP
i. 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
'pe rf nuance of the work for which this permit is issued.
. ' I ave 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.
Sq. Ft Floor Area:
Valuation: $7200.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
342 59 014
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 ainst liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
this permit.
may accrue ago st aid City in consequence l the granting all
Additionally, the�app cant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations p r e Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 4/5/2017
Issued by: Abby Ayende
ONVNE"- I D`F�R ACLARATION
Date: 04/05/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the properly or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 4/5/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
i. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by th y Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with t e C pertino Municip ode, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety ode, Nections 25505, 55 and 34.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen .
APPLICANT CERTIFICATION
Date: 4/5/2017
I certify that I have read this application and state that the above information is
CON TRUCTYON LENDING
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a con truction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 4/5/2017
Licensed
Professional
GENERAL PERMIT APPLICATION MEV
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO a
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(408) 777-3228 •FAX (408) 777-3333 • buiidinaCa cupertino.or
—
PROJECT ADDRESS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT �ICCOONTRACTOR ❑CONTRAYCTO`RAGENT 11 ARCHITECT, 1:1 ENGINEER ❑1_i1lDMIELOOPPIER` ❑ TENANT
CONTRACTOR NAM/E� so t �• ,
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USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WMDLAND ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ 1ES
EICHLER HOME? NO
DESCRIPTION OF WORK y / •I{�C < ��® "��
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TOTAL VALUATION:®
RECEIVED BY:V; V
By my signature below, I certify to of the following: I am the property owner or authorized agent to act on the property owner' behalf. I have read this
application and the information I ave ovided is on ct. I have read the Description of «cork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws Tela ' to bu ding cons con. I authorize representatives of Cupertino to enter the abov -iden 'fiedd'p�roperty for inspection purposes.
Signature of Applicant/.A. Date:
EMENTAL ATION REQUIRED
OFFICE USE ONLY
�- .-
❑ OVER-TIIE-COUNTER -
`
EXPRESS =
STANDARD
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: 0. LARGE- -
❑ NWOR
MEPMiscApp_2011.doc revised 06/21/11
qq
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