15080154CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11117 LINDA VISTA DR
CONTRACTOR: REC SOLAR, INC.
PERMIT NO: 15080154
OWNER'S NAME: POWELL BRUCE K TRUSTEE
775 FIERO IN STE 200
DATE ISSUED: 08/20/2015
OWNER'S PHONE: 4082574584
SAN LUIS OBISPO, CA 93401
PHONE NO: (888)657 -6527
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
INSTALL 11 ROOF TOP, FLUSH MOUNTED PV MODULES,
((�� (�, f
7501
License ClaCss ``E�� # 1
2.8KW
`G"l
�7Lie.
Contractort }�. I V_U t / `ZCWA Date �5 " eZo'
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
Sq. Ft Floor Area:
Valuation: $6000
rformance of the work for which this permit is issued.
I ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35626002.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
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
WITHIN 180 DAY RMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS 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,
r
costs, and expenses which may accrue against said City in consequence of the
-
Issu Date:
granting of this permit. Additionally, applicant understands and will -com I
g g P Y, PP � P Y
y: ,.- - --r= =--
with all non -point source regulations per the Cupertino Municipal Code, Section
- ROOFS:
All be inspected any roofing material being installed. If a roof is
9.18. _^ i
�1� � � �C
I Date J
Si ature
roofs shall
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
Code, for the of the work for which this
the Health & Safety Code�Sions 2550 255 3 a 25534.
�� `-
Section 3700 of the Labor performance
Owner or authorized age Date:
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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building acupertino.org
PROTECT ADDRESS ( `
I
APN# E) (6 �(o
OWNER14AME
PHONE O 4046 �(��j11 E -MAIL
"�(E `�C
STREET ADDRESS � 0tv _. �� Poar, e
�'j FAX
CITY, ^ ,
�/('t
CONTACT NAME ' j�0 /�
®� 1
PHONE
�f
E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGE CONTRACTOR ❑ CONTRACTORAGENr ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
ICENSE NUMBER
LICENSE TYPE,
BUS. LIC #
,
d�
� d�
COMPANY NAME
E -MAI _ -
A' mil,
FAX
ST ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi - Family
PROTECT IN WILDLAND
PROTECT IN
STRUCTURE: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes \ \ \\ NO
FLOOD ZONE El Yes Dl-,NO
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
FOSOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY): �J r (y
TOTAL VALUATION:
DESCRIPTION OF WORK Cdr V J [ QQ 2 1--L
�L M y d Vt
PEW
Ell
By my signature below, I certify to each of the following: I am the property owner-or authorized agent to act on operty 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 b ' ding const ction I ut
ize re resentatives of Cupertino to enter the aentifie property for ction purposes.
(� /j ll
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
h33h
ig
RA....
R: {7
't'
'
4x5
PJlApp_2011.doc revised 03116111
CITY OF CUPERTINO
FFF. F.CTTMATnR — RTTTT.DINr DIVISION
imADDRESS:
11117 LINDA VISTA DR
DATE: 08/20/2015
REVIEWED BY: MELISSA
APN: 356 26 002
BP #: /5- _
"VALUATION:
1$6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
0.0 T
PENTAMATION
PERMIT TYPE: SOLAR -RE
WORK
INSTALL 11 ROOF TOP FLUSH MOUNTED PV MODULES 2.8kW
SCOPE
$0.00
Ifech. Plan Check 1'Iurrab. Pkiri C "heel, F7cc'..Plar Check
blech. Permit Fee: Plumb. Permit Fee:
F,lec. Per rrit Fee:
Other illech. Iris ».
_}1ech. hlsp Fee:
0(her• Plumb fav).
Numb. Insp. Fee:
Other hllec. Jnsl:>.
Vec. Imp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Pire, Sanitary newer uasrracy acnooi
see- 11. t mritart tho Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$236.00
Alternative Energy System
/PHoToVRES Photovoltaic System
Suppl. PC Fee: E) Reg. 0 OT
0.0 T
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.Onsh,IdCttOn Tax
Administrative Fee:
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
0
Trawl Doc uirienioliori Fees,:
Strong Motion .Fee: 1BSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
' 3
SU'gTOTALS
$1.78
x
$236.00 TOTAL FEE
$237.78
Kevisea: uriuu/_uio
CITY OF CUPERTINO BUILDING PERMIT 1
BUILDING ADDRESS: 111 t7 LINDA VISTA DR I CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15080154
OWNER'S NAME: POWELL BRUCE K TRUSTEE 1 775 FIERO LN STE 200 1 DATE ISSUED: 08/20/2015 1
OWNER'S PHONE: 4082574584 1 SAN LUIS OBISPO, CA 93401 1 PHONE NO: (888)657 -6527 1
LICENSED CONTRACTOR'S DECLARATION
icense Class Lic. 4
Co ntr r /y Date
I he affirm that Iii. 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.
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 thh
granting of this permit. Additionally, the applicant understands and will co plT1p
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Si" ure Date $ Z (.4
l
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
1, 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:
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.
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL 10 ROOF TOP, FLUSH MOUNTED PV MODULES,
2.6KW
(SCOPE IF WO RE IS NEW SET OF PLANS -
CHANGED Z6�
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 35626002.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DA ISSUANCE OR
180 D OM LAST, ED INSPECTION.
v
Issued b y: Date:
All roofs shall be iat%S t tt 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:
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
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, �255 33, and 25534 .
Owner or authorized ate: I
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • build ingPcupetno.orq
05Y B µ
NEW CONSTRUCTION ❑ADDITION ❑ ALTERATION / TI Y:iREVISION / DEFERRED ORIGINAL PERMIT k I SC:)9 O
PROTECT ADDRESS 4VS_\-rA —L-), AIN �' S Z
OWNER NAME PHONE Ov)2 rR �ZEEAI
L
STREET ADDRESS I (� � ) CITY, STATE, ZIP p,..�y FAX
CONTACT NAME PHONE
STREET ADDRESS CITY, STATE, ZIP ({•1p FAX %N r`M - cD W
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �, X,, `_ LICENSE NUVIBER�,4 LICENSE "rypE BUS. L1C N
COMPANY NAME c � ,^w` E -MAIL FAX
STREET ADDRESS 2 �j ♦� `Q�- 2 6V% V
W 1 n ` CITY, STATE, ZIP J _ �,� /1 �j� r HONE
ARCHITECr/ENGINEER NAME v •"V v dLICENSE NUMBER _ ` 1 BUS. LIC N
COMPANY NAME E -MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK A �, C ``
"'V I v_ '
t rv� lcw 2.
EXISTING USE PROPOSED USE CONSTR TYPE k STORIES
USE TYPE OCC. SQ.FT. VALUATION (;)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
ATTACH
k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES
BEING ADDED? []NO ADDITION? ❑NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ ECE'IVEA ICY; - TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or Ize age n t e e e I have read this
application and the information I have prov ed is correc I have read the Description of Work an veri y it is accurate. I agree to con with all applicable local
ordinances and state laws relatin t ons/jn nze r atives of Cupertino to enter the above-iId ptified pro :rty fo inspection purposes.
Signature of Applic gent: Date:
ST V41tTMENTA L INFORMATION REQUIRED „PLAN�cHEC>�Ty "M �:, ROUTUgQS
< P ,
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ "oyER Tx�-coUNER ❑ BUTQ)TNr, uI A6 REVfE r
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS; ` ❑ PLAtvNAVGPLAN W o
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑'ST AIW ❑ �k%JULTC, ORKS
form if any Hazardous Materials are being used as part ofthis project.
❑, LARGE ❑ - FIRE DEPT -'
Copy of Planning Approval Letter or Meeting with Planning prior to `
❑ MAJQR, ❑ SANTTARX SEG1 ER DISTRIC."T
submittal of Building Permit application.
❑,' ENWRONMENTAL HEALTH
B(dgApp_2011.doc revised 06121111
W9
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
IlaADDRESS:
11117 LINDA VISTA DR
DATE: 08/26/2015
REVIEWED BY: MELISSA
MISC ITEMS
APN: 356 26 002
BP#: 15080154
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
SCOPE IF WORK REVISED. NEW SET OF PLANS - CHANGED 8/26/15
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nidrhl. aM_) Thece feec are hacod nn the nroliminary intnrmntinn availahle and are nn1v an Pstimale. Cnnlacl the 1)ont fnr addn'1 infn_
FEE ITEMS (Fee Resolution 11 -053 Ef . 7il/13
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
0 hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
E)
Work Without Permit? C) Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
I Building or Structure
E)
0
i
Ji'(4),cl
Strong Motion Fee:
$0.00
$143.00CITA:
Select an Administrative Item
$143.00
Bldg Stds Commission Fee:
:SiTC7►T5;
$0.00
$0.00
Revised: 07/0212015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: I 1 117 LINDA VISTA DR
CONTRACTOR: REC SOLAR, INC.
PERMIT NO: 15080154
OWNER'S NAME: POWELL BRUCE K TRUSTEE
775 FIERO LN STE 200
DATE ISSUED: 08/20/2015
OWNER'S PHONE: 4082574584
SAN LUIS OBISPO, CA 93401
PHONE NO: (888)657 -6527
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
�` —7 C/
(. SO b
INSTALL 11 ROOF TOP, FLUSH MOUNTED PV MODULES,
License Clas s , t !I e
2.8KW
� l / �jLic.
q� (ZCfA 'ZQ — ' 5
Contractoa)n ` / Date
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
Sq. Ft Floor Area:
Valuation: $6000
rformance of the work for which this permit is issued.
1
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
APN Number: 35626002.00
Occupancy Type:
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 DAY IT 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
180 DAYS LLED INSPECTION.
indemnify and keep armless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City n consequence of the
p y � y
granting of this permit. Additionally, the applicant understands and will comply
Issu —,.r
Date:
y
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
TaSA ZU f S
ROQES:
Signature Date ' -
All roofs shall be inspected 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 BETT ER
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
the Health & Safety Code, S lions 2550 255 3, at 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
1(,�� Dater 2
Owner
permit is issued.
or authorized agent:
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
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
1 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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(c)cupertino.org /�%��O /57
PROJECT ADDRESS i I % kyoA \j ` a `
APN N '
OWNERNAME /�r /7 PHONES qS,6 E -MAIL
STREET ADDRESS
A E
CITY, , "00 CA ;no 1 FAX
CONTACT NAME -P PHONE
�w!
1
E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGE - CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGR EER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ICENSE NUMBER
solli0
LICENSE TYPE(, " l (,
`�
BUS. LIC N
COMPANY NAME V
E -MAI jq
FAX
STREET ADDRESS (n]h
CITY, STATE, ZIP
PHONE 20 ''^^
ARCHITECT/ENGTNEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 1 SFD or Duplex ❑ Multi- Family
STRUCTURE: ` ❑` Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes XNo
\ \\
PROJECT IN
FLOOD ZONE El Yes It--,No
SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELSAJN1TS: j KILOWATTS (COMMERCIAL ONLY): r (�
TOTAL VALUATION:(
DESCRIPTION OF WORK
�I r
voo
r� fir, Id '�� t.. Wn'�. r��.�� , a✓�4 - �a�a"'�"iw 9u ?..Fr t:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on operty 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 ''din coast ction I ut ize re resentatives of Cupertino to enter the ab identifie property for inspection purposes.
Signature of Applicant(Agent: Date:
S
SUPPLEMENTAL INFORMATION REQUIRED
w '
I
IN
PVApp_201 Ldoc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Wwrirt_ etch These fees are hated on the nreliminary information available and are only an estimate. Contact the DeDt for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
ADDRESS: 11117 LINDA VISTA DR
DATE: 08/20/2015
REVIEWED BY: MELISSA
APN: 356 26 002
BP#:
`VALUATION: 1$6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PENTAMATION
PERMIT TYPE: SOLAR -RE i
WORK
INSTALL 11 ROOFTOP, FLUSH MOUNTED PV MODULES 2.8kW
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Wwrirt_ etch These fees are hated on the nreliminary information available and are only an estimate. Contact the DeDt for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1rrtrr��lrra r °. r' °rr.�:
0
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
i
l nn / Fc("s
Strong Motion Fee:
1BSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
iI$TC'TAU
$1.78
$236.00
",`:TOT FEE:
$237.78
Revised: 07/0212015
CUPERTINO
WATER- CONSERVING PLUMBING FIXTURES
PERMIT CANNOT BE
UNTEL TIUS CEIRTEFICATE
Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form.
I. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 2.
Date:
Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water - conserving plumbing fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply,
❑ The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature:
*No Go to Question 3.
Date:
3. Is water service permanently disconnected for your building?
❑ yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the fonn.
Owner' Signature:
No Go to Question 4.
Date:
4. ja your real property built and available for use or occupancy on or before January 1, 1994?
No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
Date:
My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
❑ My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non - compliant plumbing
fixtures to be replaced with water - conserving plumbing fixtures throughout the building. On or before January 1,
2017, all non - compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements). � 0AUST_ S 1Giv
El My property is a multifamily residential real property. See Civil Code Section 1101.5. ahGK P AG E
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
SB407 2015.doc remised 02104115
t
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water- conserving �Q
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
UWe, the owner(s) of this property, certify under penalty of perjury that non - compliant plumbing;xtures will be replaced
prior to date specified above with water - conserving plumbing fixtures in a rdance with Civil Code Sections 1101.1 through
1101.8, the current California Plumbing Code and California Green ing Standards Code, and manufacturer's installation
requirements, and that the water- conservijUA00 fixtures c y with the requirements as indicated in the tablerbelow.
Owner's (or Owner Agents) Sigq tore:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 02104115
Non - Compliant
Water - Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.,,
2013 CALGreen Div. 5.3
Single - Family
Multi - Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons /flush
(Toilets)
Gallons /flush
Dual flush toilets: 1.28 gallons /flush effective flush volume (the composite„',
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons /flush
Gallons /flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand -held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and /or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time. )
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per mll�nute
1.8 gallons per minute @,60
Kitchen
per minute
60 psi
@ 60 psi
psi w
Faucets
May temporarily increase
May temporarily"
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction..
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 02104115
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildino(Dcuoertino.org
FILI
Permit No. ''w �LL e
Address // /j e;111A 161 3-A, XP 4 of Alarms Smoke: Carbon Monoxide:
PURPOSE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for.
inspections are required.
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon.
Monoxide Alarms be installed in the following locations:
AREA I
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
_
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
1 have read and agree to corDp g v✓ith the terms and condoms of this statement
Owner or Owner A ent's tame:
9
W
`
�
Si nature.. ......... �/ .......... .. .
.............................. ............................... Date: ...................
Contractor Name:
�v ,. zytiO
Si nature .............. .......................... ......... Llc.# ...7.SC?.1:6..1.......... Date: ...:+- ....
Smoke and CO form.doc revised 03118114