B-2016-1202CITY OF CUPERTINO BUILDING PERMIT
13UIMINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1202
10497 ANSONAVE CUPERTINO, CA 95014-1346 (326 41 110)
(SUNWORK
RENEWABLE ENERGY
PROJECTS)
MILPITAS, CA 95035
OWNER'S NAME: ZAVISLAK MARK J AND ZHENG CHEN
DATE ISSUED: 01/15(2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMT INFO:
License Class Lie. # z v'73 1—
Contractor t SUNWORK RENEWABLE ENERGY PROJECTS) Date��/�f�6
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MEGA X RESIDENTIAL ,,,_ COMMERCi[AL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
Install (12) rooftop mounted solar panels (3.360 KW)
I hereby affirm under penalty of perjury one of the following two declarations;
1. 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.
1 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.
Sq. l`t Floor Area:
Valuation: $8000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
"N Number;
Occupancy Type;
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
326 4l l i0
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City In consequence of
granting of this permit. Additionally, the applicant understands andd will
WITHIN 1.80 DAYS OF PERMIT ISSUANCE OR
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
Issued by�9 VA t ++
Signature Date PJJS/06
Date:
OWNER-BUII.DF,R i XCLAR ATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
11 1, as owner of the properly, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business &Professions Code)
Signature ofApplieant:
2. I, as owner of the properly, am exclusively contracting with licensed
Date:
contractors to construct the project (Sac,7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A}' OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work far which this permit is issued,
I have read the hazardous materials requirements under Chapter 6.95 of the
i. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any poison in any maturer so as fa become subject to the
au' contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, atter making this certificate of
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent: �. '✓ r�P
be deemed revoked.
Date: f/idle
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Signature Date
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTI t40 (408} 777-3228 •FAX {408) 777-3333 • buifdinclCa cupefto.arg
PROJECT ADDRESs
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❑ CONTRACTOR ❑ CONJRACTOR AGENT ❑ ARCITTr'-CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEpP-/C 4A -%{.!V 1voa-C..
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ARCMTECTIENGINEER NAME
LICENSE NUMBER
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COMPANY NAME
EMAIL
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STREET ADDRESS
CITY, STATE, ZIP
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USE OF >rSFD or Duplex D Multi -Family
STRUCTURE: ❑ ComlTlereial•
PROJECT IN WILDLAND
URBAN INTERFACE AREA [IYes �o
PROJECT IN
FLOOD ZONE ❑ Yes ;� No
SOLAR PANELS
=EIELECTRIC VEHICLE CHARGING STATION
Cl SOLAR WATER FMATINO
❑ OTHER:
FOR SOLAR PAATLS.• NUMBEROFPANELMJNITS: t/L
KILOWATTS ICO : 3•I 60
TOTAL VALUATION;3
OitQ�
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DESCRIPTION OF WORK-� r� c-✓
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By my signature belmk% I certify to each of the following: I am the property owncr 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 verify 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 -identified property for inspection purposes.
SignatumofApplicandAgent:_ Date:.
STJPPLEMENTALINPOnIATIONREQUIRED
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PURPOSE
5MOKE f CARBON MONOXIDE ALARMS
OWNED: GERTiFICATE OF COMPUANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 « FAX (408) 777-3333 - buildingQcupertino.org
ev Ave"
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
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
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 inust be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that tlae alarm(s) referenced above has/ -have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and Cali font rda- Residential Codes. The alarms have been tested and are operational, as of the date sigmedi
below.
P 111d'vd retia; anar
to, COMID ! wrth. the; tor.r 1 S.
conditions. of this statement
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Date:
Stroke and CO fbmn.dbc revised; 035'8114;
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO + 10300 1 RR E AVENUE o CUPERTINO, CA 95014-3255
(49081777-3228 •FAX (408) 777-3333 B buildingC-cupertino.org °> _
Owner NamPermit No
Address �� ��5-��✓V 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.
B�—Vo 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 1101.1 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.
B-1�6 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.
0� 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.
a E Yes 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. Please check ONE of the following:
0`_ 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).
❑ My property is a. multifamily 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 1101.1
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 nage. _.
Owner or Owner Agent's Signature.. I/ Datf;J
Upon completing and signing this Certificate, as return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15