15100147CITY OF CUPERTINO
BUILDING ADDRESS: 10307 JUDY AVE
OWNER'S NAME: TODD CREAMER AND DENISE EVERHAM
OWNER'S PHONE: 4089738417
W LICENSED CONTRACTOR'S DECLARATION
License Class '44 Lie. # Si (fl: t
Contractor Toy' &a. CM PJWgate 1 /
I hereby affirm that I am licensed under the provisionsIfCh.pt�
(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:
t. I have and will maintain a certificate of consent to self -insure for Worker's
p Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. 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 hamiless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this ermit. Additionally; the applicant understands and will comply with
all non-po so ce regulation the Cupertino Municipal Code, Section 9.18.
Signa a Date l i
® OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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 (See.7044, Business & Professions Code)
2. I, 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:
t. 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.
2. 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.
3. 1 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
INC
20861 WILBEr
CASTRO VALI
JOB DESCRIP
INSTALL (N) R(
KW)
Sq. Ft�Floor An
�
APN Number: 2
PERMI'
WITHI:
180 Dr3`
Issued by:
All roofs shall be
installed without
inspection.
Signature of App]
ALL
I have read the t
California Healt
compliance with
Safety Code, Sec
Additionally, shi
contaminants as
maintain compli
He^ & Safety
vwyer or autni
I hereby affirm t
for which this pt
Lender's Name
Lender's Addri
I understand my
Licensed Profe;
G PERMIT
THE SOLAR COMPANY, i PERMIT NO 15100147
AVE STE 1 DATE ISSUED: 10/19/2015
CA 94546 PHONE NO: (510) 214-9005
)N: RESIDENTIAL ❑ COMMERCIAL
TOP MOUNTED SOLAR - 10 PANELS {3.3
Valuation: $10000
Occupancy Type:
EXPIRES IF WORK IS NOT STARTED
180 DAYS OF PERMIT ISSUANCE OR
3 FROM LAST CALLED INSP CT ON.
1
Date: qJ206
RE -ROOFS:
ected prior to any roofing material being installed. If a roof is
obtaining an inspection, I agree to remove all new materials for
COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
zardous materials requirements under Chapter 6.95 of the
& Safety Code, Sections 25505, 25533, and 25534. I wilt maintain
ie Cupertino Municipal Code, Chapter 9.12 and the Health &
on 25532(a) should I store or handle hazardous material.
ld I use equipment or devices which emit hazardous air
efined by the Bay Area Air Quality Management District I will
ice with the Cupertino Municipal Code, Chapter 9.12 and the
'Ode, Sections 25505, 25533, and 25534.
Date
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance of work's
it is issued (Sec. 3097, Civ C.)
ARCHITECT'S DECLARATION
shall be used as public records.
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 Arms
CVP i'I t
(40 8) 777-3228 $FAX (4€38) 777-3333 a Strildir a Cu erii ,
Aff wt:
10307 JUDY AVE.
.._ 375-08-046
408-973-8417 - CREAMER108@YAHOO
?�? 10307 JUDY AVE. ,rqyCUPERTINO, CA 9501411�vmxll.
CON'S ACT ,N.mfE
Andre Laines � PHONE 209-418-894
TSCdesign@TheSolarCo.com
STREET ""Ell 20861 Wilbeam Avenue crr,(. STA
FAX Valley, CA 94546`877-527-7339
D OWNER 0 OWNER—BUILDER CI nlVN-,IZ An;.�T 171 rl
DESCRIPTION; OF NVORA ,
Install 3.3 kw grid tied solar electric system (PV)ROOF mount
By Trey sipatare below, I certify to Pop ofthe followrinT: I am she property owner or authorized agent in a6t on the pii-pedy owners behalf, I have read dais
applicasion and the iaformation I ave)ro± ideti is comet. read the Description ofWork and verify i as accura gicI agree in eamply with all applicable ?o a?
ordinances and state laws rata ' g to ilding contraction, thome r reser Lives of Cuperdno to enterl the above-/ ntift ? pmper#y fnr FraspQction purposes,
/w
OFFICE USE ONI
103
PV4pp 201€.doc revised 03-`16111
CtrNMAC ORNAME
The Solar Com an Inc
LICENSE IffiM rR 596651
i.ICE?aSE TYPE
B C46
sus. r.Ic u 31418
CO. A:wYNANIE The Solar Company, Inc.
E'"
FAX
Andre TheSolarCo. om
877-527-7339
ST�i T PJ iESS
20861 Wilbeam Avenue--,..
CITY, STAT E ZIP
I FIO vE
87 7-607-6527 x 710
1tGZIITECTIE iGislF"F.ER +tA2t4E
LIti i='.SE .k°ii 73RR. -
BUS. LIC #
C OMPAIYYNMC-
F MAIL
FAX
STREET. ADDRESS
-
CITY, STATE, ZIP (
Piifl7v''
..
USE OF a SFD or Duplex Li W16 -Family
PROJECT IN e LLDL: ACs
PROJECT IN
S'rRLimmc. Cl Commercial
URBAN INTERFACE AMX Yes llX No
FOOD ZONE ED tiles CI No
D(SOI-AR PA-NELS
❑ ELECTRFC-VMMCLECILARrLNGS'TATIO?d
SOLAR WATER H EATING
EI OTIzER,
rORSOLARA411VE4S., x A� 10
KILOWATTS (COMA ERCIAL Ong t7 I
T�z� � � �� s� ; 10000.00
DESCRIPTION; OF NVORA ,
Install 3.3 kw grid tied solar electric system (PV)ROOF mount
By Trey sipatare below, I certify to Pop ofthe followrinT: I am she property owner or authorized agent in a6t on the pii-pedy owners behalf, I have read dais
applicasion and the iaformation I ave)ro± ideti is comet. read the Description ofWork and verify i as accura gicI agree in eamply with all applicable ?o a?
ordinances and state laws rata ' g to ilding contraction, thome r reser Lives of Cuperdno to enterl the above-/ ntift ? pmper#y fnr FraspQction purposes,
/w
OFFICE USE ONI
103
PV4pp 201€.doc revised 03-`16111
CITY OF CUPERTI O
FEE ESTIMATOR — BUILDING DIVISION
M--L_
ADDRESS: 10307 Judy Ave
DATElid: 1019/2015
REVIEWED BY: PAUL
APN: 375 08 046 BP#:
'PERMIT TYPE: Building Permit PLAN CHECK TYPE:
PRIMARY _7
SFD or Duplex
WORK Install N rooftop mounted solar- 10 Panels 3.3 K
*VALUATION: j$10,000
Addition
PENTAMATION
PERMIT TYPE: SOLAR -RE
SCOPE
);'lec, t t rrr tt foe:
C),'lrc:z .i;ti:(kt. t: t. , _.
f:t'.ei Plumb /nt o.
{fit `ie;' ' !t c°. hls,0>
lnsp. Fee:
!'1'i iib. Insp. {'L+,>:
t?'.ic'c. �f?.SF'?. 1"ee:
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i"Onst `uctl.On Tax:
Al;iiniflistrativi Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
"vvrc: a ms estimate aoes not Include fees due to other Departments (i. e. Plannin�, Public Works, Fire, Sanitary Sewer District, School
District. ete ). ?`hese fees are haeod n" tho
FEE ITEMS (Fee Resolution 11-053 E . 711113)
:Yi:'i;h. ijud7l (-FtCtck
Phwilx IaAin (. J eul!
I' /G'{7. f�(LZPt C h cn
t.iPcft. l' ; a t Fee:
f'lae nt:, Pe'rinef Fe(%
);'lec, t t rrr tt foe:
C),'lrc:z .i;ti:(kt. t: t. , _.
f:t'.ei Plumb /nt o.
{fit `ie;' ' !t c°. hls,0>
lnsp. Fee:
!'1'i iib. Insp. {'L+,>:
t?'.ic'c. �f?.SF'?. 1"ee:
"vvrc: a ms estimate aoes not Include fees due to other Departments (i. e. Plannin�, Public Works, Fire, Sanitary Sewer District, School
District. ete ). ?`hese fees are haeod n" tho
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FK T,
MISC ITEMS
Plan Check Fee:
$0.00
1
$236.901
Alternative Energy System
IPxoTovREs Photovoltaic System
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i"Onst `uctl.On Tax:
Al;iiniflistrativi Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Strong Motion. Fee: IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1
$1.00
SUBTOTAI.
$2.30
$236.0
- TOT�>1 FEE:
$238.30
Revised: 10/01/2015
CUPERTINO
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLI]ANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 o building cDcupertino.org
low .,
PERMIT CANNOT DE FINALED AND COWLETED UNTIL. THIS CERTIF'ICAT'E
HAS BE, AND RL;'TURNED TO THE BUILDFq G DIA71SIOIN
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
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 wlv.ch do not contain fuel-bumuzg 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 comply with fh terms and conditions of this statement
0av�rr_er or O.wnerftgent-s,),Narge:
�Yil G e C V L Gt
4S: na{Ure.t<" ``f'
. .... ....... ................................................................................. ...............
Gojtracfbr>Name:
-��
Si E nq uret .............................. r Lt Da ............ te
Smoke and CO form.doc revised 03118114
rs
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES � Frm
I Kl�m
OWNER CERTIFICATE OF COMPLIANCE yy
wCOMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION is
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
ldnAl 777-A99R . F
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.
JV 171—No 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.
10 `9� 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.
jo PSNo 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.
11 1:4LYes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
] 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 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 N ater-conse ing plumbing fixtures comply with the requirements as indicated in the
table on the followine Mae. L _
Owner or Owner Agent's Sign
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
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