15120165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21580 EDWARD WAY CONTRACTOR:CLEAN SOLAR PERMIT NO:15120165
OWNER'S NAME: BEYDA WILLIAM J AND CATHY S 1445 KOLL CIR STE 109 DATE ISSUED:12/17/2015
OWNER'S PHONE:6503911906 SAN JOSE,CA 95112 PHONE NO:(408)217-8876
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E COMMERCIAL ❑'
INSTALL(N)ROOFTOP MOUNTED SOLAR PV-23 PANELS .
License Class�� � Lic.# (7.94 KW)
Contractor ( (i' Date C
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:$4.2164
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 APN Number:35618017.00 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 DAYS OF PERMIT 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 FROM LAST CALLED INSPECTIO '.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ' �[ ,�,��
Issued costs,and expenses which may accrue against said City in consequence of the Id b ?0UJ-0C�C�L l Date:
granting of this permit. Additionally,the applicant understands and will comply y' a
with all non-point source g lations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Sign re f Date_ 5 All roofs shall be inspected prior to any roofing material tieing 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 theLabor 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 u icipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, 533,and 534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag Date (� C
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 CONSTRUCTIONLENDING 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
ALTERNATIVE ENERGY PERMIT APPLICATION
' COMMUNITY DEVELOPINENT DEPARWENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTI K0 (408)777-3228• FAX(4:08)777-3333-building(a).cupertino.org 1 j 65 e
PROJECT ADDRESS ,tom ! (.X i I APN m356 p 1'
OWNERN AME ` I P-ONE n E-MAIL
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STREET ADDRESS CITY STATE,ZIP ( FAX
CONTACT DAME OTE E-MAIL
STREET ADDRESS c c CTTY ATE,ZIP Q FAX C
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ow.,,iR ❑ owiza-BUILDER ❑ O\MNMAMN`T NT1LA.CTOR ❑CON-RACTORAGENT ❑ ARCHITECT ❑ENGnIMbR ❑ DEVELOPER ❑TENANT
CONTRACTORNAhAE LICENSENLTABE LICENSETYP BUS.LICn
cONP NA1;AE j E-MAIL FAX
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TREET PHOTADDRESS , C ,-TATE,ZIP -
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ARCHITECTIENGINEER NAMB I LICENSE NUMEER I BUS.LIC'
COI+APANYNAME E-MAIL + FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF XSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFAC£AREA Q Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
-PtSOLAP,PANELS ❑ ELECTRIC VEHICLE CHARGING STATION To SOLAR WATER HEATING ❑ OTHER;
FOR SOLAR PANELS: NUMBER OF PANELS(L'TITS: KILOWATTS(COhAhiERCI.4L ONLY): TOTAL VALUATIO : � ho g
DESCRIPTION OF WORK
-7 ,9L(-
By my signature below,I certify to each of the following: lam the property oNNner or authorized agent to act on the property�I3mer's behalf. I have read this
application and the information I have provided is c ect. I have read the Description of Work and verit,it is accurate. I agree to comply with all applicable local
ordinances and state la%vs relating to building co ru ion. I autho i0_e representatives of Cupertino to enter the above-identified p operty for inspection purposes.
S ignature of Applicant/AEe Date:
�4114 444
S PLEV \T L INTFORMATION REQUIRED
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PIl.4pp_2011.doc revised 03116111
CITY OF CUPERTINO I tj f 5 .
ry FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21580 Edward'Way DATE: 12/17/2015 REVIEWED BY: PAUL
APN: 356 18 017 BP#: 'VALUATION: 1$42,164
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY PENTAMATION
SFD or Duplex SOLAR-RES,
USE: PERMIT TYPE: a
WORK Install N rooftop mounted solar PV-23 Panels 7.94 K
SCOPE
NOTE This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Ff,( 7/71132 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 #' Alternative Energy System
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $236.00 IPHOTovREs Photovoltaic System
PME Plan Check: $0.00
Permit Fee $0.00
Suppl. Insp.Fee-(E) Reg. 0 OT Q,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? Yes (E) No $0.00
Advanced Plann y Fee. $0.00 Select allon-Residential
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $5.48 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS $7.48 $236.00 1, TOTAL FPE $243.48
Revised: 10101/2015
S3�106CE 1 CA,E SON NI NO IDE 4RM
COMMUNITY"DE11EL'OPI,AEIVT tDEPIlR7MEld f•I#IIILDINSDIVISION,
CU PEIit f'IN O 10300_TORRE AVENUE•CUPERTINO,c�►ssa to- zss
777228•FAX=(408 777`333.3'•binlii(n cuaertirl4 oro
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PEitMIT COT, 1;kA�?LED,AND COILi .IU1 .T�rSERTIFI( TE �
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This.:affadavit is a self-cert ficah n for the ulstallahon of all�requrfed Siriolce _AJC lIonoxicie�]aims.f4r.
cc) h' ncc"with 2013,CRC Section R31-4,2018 CBG Sections 420: and=90i 2112 �liere no=ulteri9r"access for
inspections-are required,
_ _ e
GE`RAI-INFORMATION; -
Exlsttng stngle-faYnly and multi;fam�ly d ctieilrngssllali be:proded with SnnokeAlarms and Carbon:
Monoxide alaxms, When:the ctaluatrori of a4'z 4' s alterations,or repairs to exlshng d�lreli,r►g uiuts-exceeds.
$1Q00 00,CRC Settlon 12314 and CBC Sections 902;71.5 and 420:0 require that Smoke Alarms and jor Carbon.
1vTorioA&ATarms_be-installed ti the follov, g loca#ions, _=
A17EA 040, E4lA IRM . CO A1LAkM'
Outside of'eaeh separatesleennrnedfate vicul[ty of theC X
bedroomfs
On.ene -level` E a dv►> ihn :urnt ii dtidin :basements" X X:
Uhitliin:each:slee in zoom
Carbon hiotiaxide aIarrns are not regtued in dwelimgs Hrlich Banat coxttain fuel bummg appliaices;and that
do:r►otl-iave anattached garage. Carbon monoxide:al�rrns combanedv�th sin4ke alarms:shaIl comply Kith
CBC Section 4206 Td shall be appra��ed by the dffiee of the State Fire I�Ilarsat
Power Supply:In d: elle g uiiits`titi�ith pp commeraal power supply,alarm{s)-may lie salelk batt zy operated:
pq-sI ng dt3eIIing-units;alarm are perautted tolie sotely battery oPszated_�►=here repairs or alterations cla
not result its the rrnbval.of��rall:and ceilAng din�shs or therms is no access b means.of aifie,basement or crawl
space.Ref er_to-CRC Section R31 and CBC Seetions'9(Y7.2 IZ 4 and 420 6 2 An elec ieaY permit is r6quirod fcir
alarms'%�rhich must be connected#o file building wiring:
As owner of the above-referenced proper4T,Iherebu certify that the alarm{s�referenced abocrehasfhaze been
installed in accordance with tlie. nor ufacturex s mstrucffiDns and.m compliance With t1te-California.Building
and California Residential.Codes Thealarms have:been tesfeci.and are;operatton�l,as of.the=elate signed
below.
1 have eas-arid a'ree to'coria with=if�e terms andc�riditioris�thts statement , J
er,'(or— met s)
-' I cJ wt 7Skineti►;e: .f.— G�/ .. .Date:
£ontpa for Nacre, / l
���v Sa f Gt V sienafi�e: i�c. .G✓._ c Date:�� !.�
SmOke aro+CO farot.duc revised 0.'V1811
IFLE
777707
ELIWATER-CONSERVING PLUMBING FIXTURES /c77
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO.CA 95014-3255
1 (408)777-322 •FAX(408)777-3333•buildinga(�cupertino.org
Owner Name haf,lfc, Permit No.Cwol
Address 4�t
1. Is your real property a registered historical site?
❑ Yes_ Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
f] Go to Question 2.
2. 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?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
2-'No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101..1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
"o Go to Question 4.
4. Is 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. Skip the rest of the form and sign bottom of form.
G'Y es 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. Check one of the three following statements and sign
bottom of form..
5. Plea heck ONE of the following:
Pproperty 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).
❑ My property is a muldfamily.residential 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.
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.
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).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing.fixtures in accordance with Civil Code Sections 110 1.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: i Date:
Upon completing and signing this Certificate,please feturn.it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115