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B-2017-0988CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0988 7720 OAK MEADOW CT CUPERTINO, CA 95014-5201 (366 26 013) SOLARCITY CORPORATION SAN MATEO, CA 94402 OWNER'S NAME: TILAK OMKAR AND JOSHI PRAJAKTA OWNER'S PHONE: 317-363-7268 LICENSED CONTRACTOR'S DECLARATION License Class= Lie. #888104 Contractor SOLARCITY CORPORATION Date 12/31/2018 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: 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 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 r he C Municipal Code, Section 9.18. Signature Date 06-22-2017 DATE ISSUED: 06/22/2017 PHONE NO: (650) 963-5100 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (N) 19 -PANEL ROOF MOUNTED PV SYSTEM (6.175 KV) - SUPPLY SIDE CONNECTION USING OPTION #1 UL REF NO.1101089153-1 TO BE FIELD EVALUATED Sq. Ft Floor Area: I Valuation: $12000.00 "N Number: Occupancy Type: 366 26 013 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, 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) 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. 2. 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. 3. 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. Signature Date 06-22-2017 Signature of Applicant: Date: 06-22-2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Catifornia 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, Se 'ons 2555, 25533, and 25534. Owner or authorized agent: Date: 06-22-2017 U CONSTRUCTION LENDING AGENCY I 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 I understand my plans shall be used as public records. Licensed Professional CUPEFMNO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bujidina c rti, a.crg PROJECT ADDRESS APN # OwNERNAME I / /� / a PHONE 3rd 3 2c &-M,�V ` � 6k w�, STREET ADDRESS Z�v aA(l✓c W Cr CITY, STATF,P,, IG �i FAX 'A'NAMEGerry Igtanloc PHONE650-759-8042 E-MAILgigtanloc@solarcity.com STREET ADDRESS 391 Foster City Blvd. CITY, STATE, ZIP Foster City, CA, 94404 FAX ❑ OwNER ❑ OwNER-BUBAER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME SolarCity Corp. LICENSEN"I"BER888104 I LICENSE TYPEC10,C 6 BUS. LIC #28844 COMPANYNAMESolarCity Corp. E-MAILgigtanloc@solarcity.com FAX STREET ADDRESS 3055 Clearview Way aTY,STATE, 21PSan Mateo, CA 94402 PHONE650-759-8042 ARCHITECT/ENGINEER NAME FLICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL ¢ FAX STREET ADDRESS CrrY, STATE, ZIP PHONE USE OF 11? SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND PROJECT URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD IN ZONE ❑ Yes ❑ No 13SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION T SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELSIUMTS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK Install (C ) rooftop mounted solar panels,(] �,/�51 KW BY* By my signature below, I certify to each of the following: Ithe property owner or authorized agent to act n the owner's behalf. I have read this application and the information I have provided is correct"aveethe Description of Work and verify it is accurate.agree to comply with all applicable local ordinances and state laws relating to�uilding constructi representatives of Cupertino to enter aboy i ntified p perty for inspection purposes. Signature ofAppli2: Agen - Date (� SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ��77 trI UU ❑ OVER THE -COUNTER ❑ >�PREss ❑ STANDARD 11 LARGE ❑ MAJOR PYApp 2011.doc revised 03/16/11