B-2016-1344 REV # 1 APP & PERMITCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1344
22918 CRICKET HILL RD CUPERTINO, CA 95014-2635 (342 35 011) ( ALL BAY SOLAR )
SAN FRANCISCO, CA
OWNER'S NAME: ZABOR ELIAS AND RUTH E TRUSTEE
OWNER'S PHONE: 408-446-3208
LICENSED CONTRACTOR'S DECLARATION
License Class C_10 Llc. #962
Contractor ( ALL BAY SOLAR ) Date 02/1712016
1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Cade and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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, £or the
Pat formance of the work for which this permit is issued.
fir/':. 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 far 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 ng'lnt,,-point source regulations per the Cupertino Municipal
Code, Section 9.yo./
I hereby affirm that I am exempt from the Contractor's License Law for are of the
following two reasons:
1. 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)
z, 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Soc.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 1 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 1 have and will maintain Worker's Compensation Insurance, as provided far
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
s, 1 certify that in the performance of the work for which Has permit is issued, 1
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.
artily that I have read this application and state that the above information is
urea. I agree to comply with all city and county ordinances and state laws
ating to building construction, and hereby authorize representatives of this city
enter upon the above mentioned property for inspection purposes. (We) agree
save indemnify and keep harmless the City of Cupertino against liabilities,
Igments, costs, and expenses which may accrue against said City in
nsequence of the granting of this permit. Additionally, the applicant
derstands and will comply with all non -point source regulations per the
ipertino Municipal Code, Section 9.18.
Date 0211712016
DATE ISSUED: 02/11/2016
PHONE NO: 415-624-3535
PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
DESCRIPTION:
ALL (N) ROOFTOP MOUNTED SOLAR (2.46 KW) - 11 PANEL'S
# 1 - ADD 3 ADDITIONAL PANELS & INCREASE KW TO 3.64kW.
OVE SUB PANEL FEED (FEED THROUGH MAIN PANEL) -
ED 2/17/16
Floor Area: I Valuation:$11000.00
APN Number: Occupancy Type:
34235011
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FunM LACE "II%D INSPECTION.
by:
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,
lure o£Appl
02/17/2016
ALL ROOF
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of file
California, Health & Safety Code, Sections 2550S, 25533, and 25534. 1 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 At en Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec ' ns 25505, 25533, and 25534.
Owner or authorized agent:
Date: 02/17/2016
TR LENDI G AGENCY
I hereby affirm that there is a c nstructio,, 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 DECLARArION
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 t
(408) 777-3228 • FAX (408) 777-3333 - building dcupert! no.org
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION / Ti 0 REVISION / DEFE ORIGINAL PERMIT #
PROJECT ADDRESS `z2Ci1I� C' t`.I ln�
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❑ OWNER (] OWNER -BORDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME CCrd o5 UiiY—
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LICENSENUMBER / rLb 9/I ,
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LICENSETYPE C-/0
BUS. TIC#
COMPANY NAME
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PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK — /[ \ v q' /
�cc! he 5 s P/� ron� �(ai2 Ana 0treell, no+ t ,row- Sd� une
EXISTING USE
PROPOSED USE
CONSI'R.TYPE
#STORIES
USE
TYPE
OCC.
SQ,FT.
VALUATION ($)
F.XISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODEL AREA
PORCH AREA ➢ECK AREA
TOTALDECK/PORCH AREA
GARAGEAREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT YES
SECONDSTORY []YES
BEING ADDED? ENO
ADDITION? ENO
PRE -APPLICATION ❑YES IFYES,PROVIDECOPY OF
IS THE BLDG AN ❑YES
RECEL
TOTAL VALUATION:
PLANHWGAPPL# ENO PLANNING APPROVAL LETTER
EIC}ILERHOME? ENO
-
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on t oily 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 ate. I agree to comply with all applicable local
ordinances and state laws relating to building co s an. I authorize representatives of Cupertino to eater the above -identified property for inspection purposes.
Signature of Applicant/Agent: _ -- Date:
SUPPLEMENTAL ORMATION REQUIRED
r'�PL4N CRTEcxn're`_-
- Rourmcsilr - .-. -
❑ OVER-THC COUNTER
V❑ BUILDI\G PLAT RE\7ER' -
_ New SFD of Multifamily dwellings: Apply for demolition pelTlllt f01'
existing building(s). Demolition permit is required prior to issuance of building
-
permitfornewbuilding.
❑ EXPRESS _
�❑ PLA\ GPGANREVIEw
Cominercial Bldgs: Provide a completed Hazardous Materials Disclosure
ElSTLuvUARD
Q PUBLIC N�oRKS
_
fonn if any Hazardous Materials are being used as part of this project.
❑'LARce
❑
-
_ _ FIREDErr= -,_ _
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ n7<iaoa
' ❑ SANITARYDISTRICT
of Building Permit application.
-
,SEWER
❑ E\VIRONh1ENTALHEALTH
BldgAyp_2011.doe revised 06121111