B-2016-2060' CITY OF
CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2060
22555 SALEM AVE CUPERTINO, CA,95014-5648 (342.12 099)
SUNPOWER
CORPORATION
SYSTEMS
\
RICHMOND, CA 94804
OWNER'S NAME: SINGH INDERJEET AND KAUR MANVEE
DATE ISSUED: 06/02/2016
OWNER'S PHONE: 408-719-9387
PHONE NO: (941) 720-3850
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERNUT INFO:
License Class A.B.C-10.0-46 Lid. #890895
Contractor SUNPOWER CORPORATION SYSTEMS Date 02
8/2017
X BLDG _ELECT _PLUMB
X RESIDENTIAL _ COMMERCIAL
I hereby affirm that I am licensed under the provisions of ChapterMECH
9 (commencing.
with Section 7000) of Division 3 of the Business & Professions Coi
le and that my
license is in full force and effect.
JOB DESCRIPTION:
(N) 17 PANEL ROOF-MOUNTED PV SYSTEM (5.56 KW)
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-insare
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.
for by
2. I have and will maintain Worker's Compensation Insurance,
as provided
Section 3700 of the Labor Code, for the performance of th
a work for which this
Sq. Ft Floor Area:
Valuation: $5000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and coun
ordinances
34212 099
342
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned
roperty for
inspection purposes. (We) agree to save indemnify and keep
City of Cupertino against liabilities, judgments, costs, and expenses
harmless the
which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting o
this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE,OR
Additionally, the applicant understands and will comply with all
non-point
source regulations per the Cupertino Municipal Code, Section
.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature _—p ~�' Date
0
Issued by: Abby Ayende
Date: 06/02/2016 7
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
aw for one of the
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. 1, as owner of the property, or my employees with wages
as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended
or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting
licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business
Professions Code).
Date: 6/21201
I hereby affirm under penalty of perjury one of the following three
declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 La
or Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,
as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of tie
work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
a. 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 person in any manner so as to beco
a subject tthe
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after makng
this certificate of
will maintain compliance with the Cupertino M'cipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensati
n provisions of the
the Health & Safety Code, Sections 2 505, 533, and 25534.
Labor Code, I must forthwith comply with such provisiot
s or this permit shall
be deemed revoked.
Owner or authorized agen .
APPLICANT CERTIFICATION
Date: 6/2/2016
I certify that I have read this application and state that the abo
a information is
O TR TI LE NDING C�N�Y
I hereby affirm that there is a construction lending a ency for the performance
correct. I agree to comply with all city and county ordinances
nd state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize represeItatives
of this city
to enter upon the above mentioned property for inspection purposes.
(We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against
liabilities,
judgments, costs, and expenses which may accrue against said
City in
Lender's Address
consequence of the granting of this permit. Additionally, theapplicant
q 9 9 p y
understands
ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino
--
Municipal
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature1>> Date
2016
Professional
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELO MENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT `u' CONTRACTOR
❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
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USE OF [YSFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: [I Commercial
URBAN INTERFACE AREA E] Yes 0"No
FLOOD ZONE El Yes E iv0
SOLAR PANELS
El ELECTRIC VEHICLE CHARGING (STATION
❑ SOLAR WATER HEATING
EJ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
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SCxx�
DESCRIPTION OF WORK
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RECEIVED BY: � Ci
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I h e 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 cons tion. authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: iS
SUPPLEMENTAL
TION REQUIRED
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
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❑ EXPRESS
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❑ STANDARD
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❑ LARGE
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❑ MAJOR
PVApp_2011.doc revised 03/16/11
`d m
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
COALARM
�6U V � 6r 61 W6 H
_
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 sleepulgroom
X
i
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appli ces and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall co ply .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 batter 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, baseME nt 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 ave 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 . igned
below.
I have read and agree tchcomDly with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
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�...... i)...
Signature .... ... .....: . .. ..................... ......... ..............
ate:
ContractorName:
Signature................................................................... Lic.#......................................
ate: ...................
Smoke and CO form. doc revised 03/18114
C.UPERTIN
Owner Name
Address OP,5 j 5
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE -OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333
.- 1/-..r- ! �-._ h_ ,_. L
1. Is your, real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom o form.
O No do to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property oj 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.
❑ 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 bottcin of form.
&YNo do 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.
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:
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 plurmbin fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 201 , 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 o
improvements).
El 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 improVem nts).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing f
tures 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 mann
acturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated
in the
table on the following age.
Owner or Owner Agent's Signature: Date:
/� ,�
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building perrmt.
SB40 7 2015.docrevised 08126115