15110083OU
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRES9.- 1426 ROSEGARDEN LN
CONTRACTOR: REC SOLAR, INC. PERMIT NO: 15110083
0 NVNEkiS NAME�: tiZIiQNGPEI CHEN
775 FIERO LN STE 200 DATE ISSUED: 11/13/2015
OWNER'S PHONE: <650'5,759135.
SAN LUIS OBISPO, CA 93401 PHONE NO: (888)657-6527
❑ ICENSEDCONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
UPGRADE MAIN ELECTRICAL PANEL (125 AMP).
icens6,,C.r94kdt.
ontrild6f Date M
1 hereby: affitm that I"am- licensed under the'provisions of Chapter
(commencing with!Secti6n:7009) of Division 3 of the Business & Professions
Code: and!thAt ifiy license. isjwfull force and effect.
I hereby affirm 4in idier penalty.; "'. of peone of the following two declarations:
FJ
I have and -will iiiair 6n . a. 6lte4'ifi&ate'of'c6nsent to self -insure for Worker's
Ic i.by.-Section 3700 of the Labor Code, for the
Comp satio provided,
P91
performance pt4e' rl,-�' permit is issued.
Sq. Ft Floor Area:
Valuation: $1500
.'h'chthis
hivd and; maiiitain IWorker's Compensation Insurce, aprovided for by
Secii6d3ft of the Labor Code, :for the performance of the work for which this
APN Number: 36617036.00
Occupancy Type:
permit is, issue
APPLICANT CERTIFICATION
I certify4hat 1, have''read .this' application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply..with A city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building consirucijon and fieauthorize hereby Auorize representatives of this city to enter
upon the abov'e'ikn.:tioned prbperty,f6r inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify ariaie�lpjfiAtmksi iheCity of Cupertino against liabilities, judgments,
: , If '' 'W , ., 11�. "I s,, ''
costs ,and;ex06fises;lw hich:ifi# accrue against said City in consequence of the
. .....
Issued b Y: Date:
granting of bis P.. the, applicant understands and will co mply
.1,
with, all. non -point source regulations per ih& Cupertino Municipal Code, Section
9.18.'
ign.a�Date
e
RE -ROOFS:
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.
El OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby afflinithit I am Olempt from the Contractor's License Law for one of
the followingl.o reasons: 1! 1!,
l"
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
employees with wages their sole compensation,
1, a.9 ownd-of thei� I �'o'pertyi,,'l'r;rny as
. 6
(p!
will do: th.6.�Wpik,)aund"'the',,st'r"u'c't'ure isnot intended or offered for sale (Sec.7044,
Business. &;Piofies!3'i'dnsCodq,).'',,.;',
1, as'6wner of ihe'.Oropefty,� =,exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the p,r6lec'i(Sec.7044,1 '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. 1 will
I hereby :laffirm iinide'penalty 'eiial 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, Ci6rtificatebf Consent to self insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation,; 9 OroVided for by $6ction,3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance'Work-�
4the f6cwhich permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I haV nd m'fitifin.-Worker!s' Compensation Insurance asprovided for by
e'a' wihi a' i
: 1! iv, I-"; el, i, t�,, . - . ! I
for
the Health & Safety Code, Sections 25505, 25533, and 25534.
Sectidn 3760!bf thet db&C6deT6 r the performance of the work which this
Date:
�)caner or authorized gee v
permit is .
.issued .;•,;
1 certify, thiit in the pe ormarice of the work for which this permit is issued, I shall
not empl6y any, per manner so as to become subject to the Worker's
-,I.
' 1 11 ..1 1 t
w If; after making this certificate of exemption, I
Com'Pefisat on10s
CONSTRUCTION LENDING AGENCY
become subject ject t6 the, Woik6r�. �,Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith compl�;with',sucfi 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
an
vejfepd,this��Application d state that the above information is
correct: Fagree t6c�mpl "thIall city and county ordinances and state laws relating
y,wi
I
to building cpristtudtibrii-And hereby authorize representatives of this city to enter
upon! the aboye: r�6n'ti'one"d r
property for inspection purposes. (We) agree to save
. i . � _:-, J- . p
ARCHITECT'S DECLARATION
indemnify and, keep: harmless: thd'Cit� of Cupertino against liabilities, judgments,
costs -and. expenses"; which, may accrue against said City in consequence of the
expenses; -,p
I understand my plans shall be used as public records.
- ?.. I'l
grantingbfithis, '3'1eiiiilt.i Aditi6iihIly,'the Applicant understands and will comply
with All non -point sO'urdt, regulations per the Cupertino Municipal Code, Section
Licensed Professional
a
9.18., W
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /j//z5Ug"3
(408) 777-3228 • FAX (408) 777-3333 - building (5),cupertino.org P94W
a
3L f ry f .i j?'s} Til;
PROJECT ADDRESS�� .
`A Eiaraev, L -t --'.j
APN.9
& (o l0 (-70 '3 Q®
OWNERIdAME
PHON'r E-MAIL
S �«
STREET ADDRESS .n _ n � �
1 1�aC
CITY, STATE, ZIP q� I
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OwI\TER ❑ O\vNER-BUILDER ❑ OWNTTER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �
LICENSE NUMBER q
LICENSE TYPE
BUS. LIC 4
I
Q
CA ko
COMPANY NAME
E-MAIL a a fl �
ek'Q- PAk . VA..,, La
FAX
STREET ADDRESS a _
CITY, STATE, ZIP �� X4'0
PH
A
CA �tJ� ��%q ��
Poe
ARCHITECT/ENGINEER NAME
LICENISE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF V SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes ] No
FLOOD ZONE ❑ Yes' No
❑ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR 1d'ATER HEATING
❑ OTHER:
FOR SOLAR PANELS: I\'UMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
0 s�
DESCRIPTION OF WORK
r 9F a�"*x i�.'��..1i '��,�Y c :L!J; ftt''fr .rl�+§,•ht _r•�.}t^ Si r r ..i;^.
'REL�EID t , 'T yr x n}?ti :4 t� yvs+ �i Yfitti
s�..w:<i'Y......T��a���,rr-
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 verit, it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes.
,�
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED=34FA
�.t;�
WEN
14
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sxY s-•.}:�d r "w'�"�i � d+F '7+ Pd7�.-fit �f.`'r.(�3lrf�•-�"yty.
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PV�pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1426 ROSE GARDEN LN DATE: 11/1312015 REVIEWED BY: SEAN
APN::: BP#: *VALUATION: 1$1,500
*PERMIT'T'YPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY PENTAMATION
USE:`
8170, or Duplex PERMIT TYPE: 1 REAP2
WORK UPGRADE MAIN ELECTRICAL PANEL (125 AMP).
SCOPE
P; Check
FVul-wb,
Other.1-1hurnb
Phi,,nb, bqp� f,ee:
Elec. Plan Check 0.0 1 hrs $0.00
1 Elec. Permit Fee: IEPERM.[T
Other Elec. Insp. 0.0 hrs 1 $48.00
Lyea M-zsp�, Fee. -
NOTE., This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District; dc.).* These_ ees are based on the preliminary information available and are only an estimate. Contact the Dept for addn't into.
FEE; TEMS (Fee Resolution 11-053 Eff.'71 113)
FEE
QTY/FEE
MISC ITEMS
PNffi Plan Check:.
$0.00
Pernfil 1-ee.,
FA
PME Unit Fee:
$48.00
PME1Pe'r'mit Fee':'
$48.00
coilsi?* Ue/101" 71�x:
F
Administrative Fee:-
]ADMIN
$45.00
Work Without Permit?
0 Yes (D No
$0.00
Travel Documentation Fee:
ITRAVDOC
$48.00
'A
otio' Fee':,:.;
Strong M, n
IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee:
IBCBSC
$1.00
. .... ... ...... ....... . . .
TALS
$190.50
...........
$0.0:0 . ... EE'
$190.50
Revised: 10/01/2015
DocuSign
"O$T
)2-4799-4486-B018-6E56A7D3F1 OA
SMOKE (CARBON MONOXOE ALAW&
OWNER CERTIFICATE -OF Ccs PLIANGE U
atviMtir�i rSr aEv �ci M r�r CEPA T � ► litLDiRiG a�visiata
1000 TORRt= AVENUE, UP>=RT1W0, CA 9$014 42
(408) 77Z-32_28 28 s FAX {40s) 777,-$333 •- buildinaftUO'6 yin! �"
1 5t1
4
PERMIT Ay.TN���yyVp0 Jr O PI]�I��`�AUD AND C+C��yMPLE'��`iIM iJl`��t7��`}�L�tyZ�TUTT �S jCERT�IyF`�T�C�1
s,7L.A�.%l�1.:f#1��,['s[f, �A,��1AkiLi11 LTlil,l i.
PURPOst
This affidavit is a self-certificat ori for"the insta- ation of all required inoke mid Carbcn'Nlonoxide Alai is fob
complisnce tl-� 13 CRC Section 12,31.4, 2015 CA Sections 420:6 and .90.-2.11.2 where no'interior access fir
wspections are required.
GENERAL INFORMATION
'Existing single-family and iultl-fainiiy dwellings sliall.be provided with Sin6k-' Alarms and Carbon
Monoxide alarms: Wizen the valuation of addlOons; alteration, or repairs fo e Stift dwellizig its e*eeds
1000.00,'CRC eeticin 8314 and 0cSecfi0ns and 420.6 require �t Srr-oke Alaxrns aiid/or �arbgi
Mono ide Ala tna be ---stalled in the Tollwing Icrcat-oils
Outside of daeli separate sle!
On
area in the diatei
Carbol, Monoxide alarrns are hot xegtzired in dwellings which- do not contain ke1 h ruing ,appliances a nd tl is
do not have an .01tachedpqra&i Carbvii iion6xid abttina coi bified nr�tli si z ke_ Tarn- shad comp
ly. with:
CBC Section 420A and:. shall be approved by the Office of the -Mate Fire lvlarshta
Power Supplyi hi dwelling units witlino commercial poW- er Su�pI '' al is} may be selely battery opet_,16&
In existin�ueng uns, alarms are perm teed to be solely battery operated whcrc; repairs Or altt`atic5rt d
not result; in t%e removal of Wali a> id ceiling fii�sl�es or thieve is a10 acces y �;y Brie"aiis bf attz�� �,�s€ment Qr crawl
space. Refer to CRC Section 8814 and CBC -S tions , ..71. ar%d_ 42[lr� Z electrical p�ri7tit is require.. fc�z
alarms which inust lie connected to tete building wiring:
As owner of the Above -referenced -property, I hereby certify that the alarm xeferented above ltaoave"beei
installed a et�rdance yvith the aa�ar ufacturer's z struct ns and iii t bine liahce with the Caiif6rn a -B- ijj&ng
Axid Califowda Residential Codes. The alarms have been tested and are operational, "as ref the elate signed
below,
I have Aced grid kireb `tb carnolV wlih tha tbti s and cbndtt%ns 4M staterrre»t
X�o> CtfrieAgent`51am
Docu&i9ned by
Zhongpei Chen
1 naevi :e61U bat.2/12/201
�ratar NAME):"
29F1ED71646D476..,
4
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