15100230 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21811 RtFREDI CT CONTRACTOR:.SANTA CRUZ WESTSIDE PERMIT NO: 15100230
ELECTRIC
OWNER'S NAME: MA SAM AND DIANA 2119 DELAWARE AVE
DATE ISSUED: 10/28/2015
OWNER'S PHONE: 6502483931 SANTA CRUZ,CA 95060
PHONE 1970:(831)469-8888
LICEpNSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
License Class P INSTALL ROOF MOUNTED SOLAR SYSTEM(I 1 PANELS)(3.0
Lic.#__ KW);INSTALLATION OF EV CHARGING STATION IN GARAGE
(GE WATTSTATIQN EVWSWBH-CP03).
Contractor
-, Date � �w
I hereby affirm hatt 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 Sq.Ft Floor Area: Valuation:$13750
Compensation,as provided for by Section 3700 of the Labor Code,for the
��el,rmance of the work for which this permit is issued, APN Number:35716122.00 Occupancy Type:
e 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 PERMITEXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct.I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION.
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, Issued byAv7e� Date•le 'r��s_
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 sqUwo5pgulations per the Cupertino Municipal Code,Section 9.18.
RE-ROOFS:
Signature Date ®�� r® All roofs shall be inspected prior to any roofing material being installed.If a roof is
m - installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
E 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
t. 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(See.7044,Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
2 I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project(Sec.7044,Business&Professions Code). California Health 4 Safety Code,Sections 25505,25533,and 25534. I will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material.
�. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air
Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will
performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code actions 25505,25533,and 25534.
2. 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 Owner or oriz d a ent:
permit is issued. Date: € .
a. 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
must forthwith comply with such provisions or this permit shall be deemed Lender's Name
revoked:
i
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION
correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional
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.
i
Signature Date
ALTERNATIVE ENERGY PERMIT Alj PLIC TIG
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDIW;DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
tJPET1NO (408)777-3228•FAX(408)777-3333•buildinq�cupertino.org /
PROJECT ADDRESS - - APN# - -
21811 Rifredi Court
OWNER NAME PHONE E-MAIL
Sam Ma 650-248-3931
STREETADDREY1811 Rifredi Court CITY,STATE,ZIP Cu ertin6,Ca 95014 FAX
CONTACT NAME Kristi Cassetta PHO 831-226-9363 NE E-MAIL kcassetta@sandbarsc.com
STREET ADDRESSCITY,STATE,ZIP FAX
2119 Delaware Avenue Mu Santa Cruz Ca 95060, 831-515-5098
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT iOl CONTRACTOR 11 CONTRACTOR AGENT =❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER I. LICENSE TYPE BUS.LIC#
Sandbar 846294 C-10
`San Nydru Westside Electric dba Sandbar E kcassetta sandbarsc.com FAX 831-515-5098
STREET ADDRESSCITY,STATE,ZIP PHONE
2119 Delaware Avenue Santa Cruz Ca 95060 831-469-8888
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
Sun evit
COMPANY NAME E-MAIL ` FAX
Sam-sholing@s�ingevity.com
STREET ADDRESS CITY,STATE,ZIP PHONE
66 Franklin Street Ste. 310 Oakland CA 94607
USE OF 0 SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT.IN
STRUCTURE: ElCommercial URBAN INTERFACE AREA ❑ Yes )0 No FLOOD ZONE ❑ Yes ❑ NO
IX SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATFR HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: f KILOWATTS(COMMERCIAL ONLY)i. TOTAL VALUATION:
DESCRIPTION OF WORK
Installation of a 3.3kw grid tied photovoltaic solar array roof mount 9 g e-L
i
By my signature below,I certify to each of th ollowin : I am the property owner or authorized agent a act on the property owner's behalf. I have read this
application and the information I have pr i d I corr ct. h ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b Idi g co s io . orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 10/27/15
SUPPLEMENTAL INFORMATION REQUIRED
n ry
AXPS r
i
PVApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21811 Rifredi Court '
DATE: 10/28/2015 REVIEWED BY: Sean
APN: BP#:
*VALUATION: $13,750
*PERMIT TYPE: Building Permit PLAN CHECK TYPE:
Alteration/Repair
�P�RIM
Y SFD or Duplex PENTAMATION
PERMIT TYPE: SOLAR-RES
WORK Install roof mounted solar s stem 11 anels 3.0 k Insxallation of EV char in station in garage GE
SCOPE WATTSTATION EVWSWBH-CP03)).
11c'C1, Nan Cheek fhimb. Pic:rz t',ter,v fe c. 111an C.Iatiek
i-IeCIt. (3t_'t'flitd 1`e£': Pful7 . ,�,erini 1(.e. .f_.i PL''i"ritty'F(L
Insp.
ech. Ins;; Fee: PIIIM .Insf> f,,<e: t'iee.. / p) Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the preliminar in ormation available and are only an estimate. Contact the De t or addn'Z info.
FEE ITEMS (Fee Resolution 11-053 Ef. Z/LQ FEE QTY/FE it MISC ITEMS
0 # Alternative Energy System
Plan Check Fee: $0.00
Suppl.PC Fee: ( Reg. 0 OT0,0 hrs $0.00 $109.0;0 1CHRGSTA EV Charging Station
PME Plan Check: $0.00 = #i Alternative Energy System
Permit Fee: $0.00 $236.00 IPHOTOVRES Photovoltaic System
Suppl. Insp.Fee-.(a Reg. O OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
r.
C.onstruc°tiop T�vc: F
0
Work Without Permit? O Yes ( No $0.00
Advanced Planning Fee: $0.00 ; Select a Non-Residential
Building or Structure
i fLL'fi.'Z f}t)(°ltld?k'ntlltlt3z j('[:':i':
Strom Motion Fee: iBSEISMICR $1.79 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS $2.79 $345.00 TOTAL F1E:, $347.79
Revi C 10/01/201
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPERTiN10 10300 TORRE AVENUE>CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• building(cDcupertino.org �f a
d
' -
g-1I� ��� `��� CC��' v1 :��' t� V � Permit NT
W.:>ess garbon:Monoxide
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SNE„D AND REJUM12 TO THE BUILDING DIVISION
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 X X
bedroom(s)
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 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.
I have read and a ree to comply with the terms and conditions of this statement
�:OwneCr or Owner-Agent's)-Name:
j 2 + CSi nafure . ........... ... ......... ....... ..............
ontractor-.Na r a
a. �e , 5 � S'i as u �-�`_ tLic# � .� Date. . . 6
........ ......... ......................, ........ .. ...... ....... .........
Smoke and COfoi7n.doc revised 03/18114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIQN
CUPIERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
{408 777-3228• FAX 408 777-3333•_buildinga.cuperfino.org
Owner Name z I'll Pen-nit No.
?�
Address
t
1. Is your real property a registered historical site?
❑ Y s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and'sign bottom of form.
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 forth and sign bottom of form.
i� t`1 No Go to Question 3.
3. Is water service permanently disconnected for your building?
El l Yes Civil Code Sections'1101.1 through 1101.8 do not ap
[�No Go to Question 4. ply. Skip the rest of the form and sign bottom of form.
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.
Et 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. Ple check ONE of the following:
' It? 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 1,2013,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing. fixtures (regardless of whether
property undergoes alterations or improvements).
El 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 inanufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.I—
Owner or Owner A ent's Signature: Date_ CA.
Upon completing and signing this Certificate';please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115