14090072F.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20425 SILVERADO AVE
CONTRACTOR: SOLARCITY PERMIT NO: 14090072
OWNER'S NAME: TAM, ROBERTO
3055 CLEARVIEW WAY DATE ISSUED: 09/12/2014
OWNER'S PHONE: 4084820179
SAN MATEO, CA 94402 PHONE NO: (650) 638-1028
LICENSED CONTRACTOR'S DECLARATION
*
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALL 12 ROOF TOP, FLUSH MOUNTED PV PANELS
License Class C(0 CLk(,0 Lic.4 '::Z<Z<Z� MC4
(3.06
j
Contractor ty;-� C( Date ��- 1
J_J
KW'S)
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:
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.
Sq. Ft Floor Area:
Valuation: $7000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36939015.00
Occupancy Type:
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
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 WT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D LED INSPECTION.
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
44) y
granting of this permit. Additionally, the applicant understands and will comply_�
with all non -point sourc regulations per the Cupertino Municipal Code, Section
9.18.
,��A %
`2 Ll
RE -ROOFS:
Signature Date C �t t C
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:
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 Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code,JSens 5505, 25533, and 25534.�jSection
Owner or authorized agenDale. 1 Zl
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
CONSTRUCTION LENDING AGENCY
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
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
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
FF.F, 1FCT11V1AT0R — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rumic works,fire, Juritt"Iy .server "tat, u,
b d th l' a in ormation available and are onl an estimate. Contact the Dept or addn'l info.
Dtstrtct, etc . These ees are ase on a re tmtn
FEE ITEMS (Tee Resolution 11-053 Ef ' 7f ;1!,13)
20425 SILVERADO AVE
DATE: 09/12/2014
REVIEWED BY: MELISSA
wDRESS:
APN: 369 39 015
BP#: e�
VLUATION:
$7,000 0
o,her Cr'f.'. Insp,
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
INSTALL 12 ROOF TOP FLUSH MOUNTED PV PANELS 3.06 kVVS)
SCOPE
hs
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rumic works,fire, Juritt"Iy .server "tat, u,
b d th l' a in ormation available and are onl an estimate. Contact the Dept or addn'l info.
Dtstrtct, etc . These ees are ase on a re tmtn
FEE ITEMS (Tee Resolution 11-053 Ef ' 7f ;1!,13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
I 1 I # Alternative Energy System
$236.00 IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Reg. 0 OT
()Fi' er .}fit%dmb 1raT,.
o,her Cr'f.'. Insp,
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rumic works,fire, Juritt"Iy .server "tat, u,
b d th l' a in ormation available and are onl an estimate. Contact the Dept or addn'l info.
Dtstrtct, etc . These ees are ase on a re tmtn
FEE ITEMS (Tee Resolution 11-053 Ef ' 7f ;1!,13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
I 1 I # Alternative Energy System
$236.00 IPHOTOVRES Photovoltaic System
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. OT
p,0
hs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
O
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning I;,ee:
$0.00
Select a Non -Residential 0
Building or Structure 0
7 7olwnenlalion
Strong Motion Fee: IBSEISMICR
$0.91
Select an Administrative Item
Bldp- Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.91
$236.00 TOTAL FEE:
$237.91
Revised: 08/20/2014