15110180-FCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21438 KRZICH PL
CONTRACTOR: SOLARCITY PERMIT NO: 15110180
OWNER'S NAME: JIAO FAN AND LIU X1AOY1 TRUSTEE
3055 CLEARVIEW WAY DATE ISSUED: 11/25/2015
OWNER'S PHONE: 4083060995
SAN MATEO, CA 94402 PHONE NO: (650) 638-1028
LI LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
INSTALLATION OF ROOF MOUNTED SOLAR (31
License Class ' % Lie. # 0
MODULES)(8.06KW)
ontractor Date
rr. A 11. i �'�
—t3 JJ
I hereby affirm that I am lecenseff 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
Compensation; as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $18000
performance of the work for which this permit is issued.
11 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
APN Number: 36206038.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
`,f,,ITI3IN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which ma7ccrue ainst said City in consequence of the
ARE
granting of this permit. Addj��rally, t e applicant understands and will comply
Issued by: Date:
with all non -point source re latio `s er the Cupertino Municipal Code, Section
9.18.
ll
ignature f` Date --�1
All roofs shall be inspected prior to arty roofing material being installed. If a roof is
anyroofing
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
v
❑ 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
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 (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Se c.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25.533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Qity Management District I
performance of the work for which this permit is issued.
will maintain compliance with theCupertino mi al Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 2 3d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
/t
-dt
caner or authorized agent: Date:
permit is issued.
I 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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
'WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLEANCE
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 ^ buildin-g(a cupertino.ong
Owner Name 1 G('a`/ 1 L t uk Permit No. Q
Address 8 �_e 1 t ( -�, 9 t-\- V Z_ P(,
1. Is your real property a registered historical site?
❑s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
It No Go to Question 2.� 1/
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 110 1. 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.
1 No Go to Question 3. 7tp�
3. Is water service permanently disconnected for your building?
VNes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
o Go to Question 4._
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ o My real property is built and available for use or occupancy after January 1, 1994. -3 15
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
19 ❑ Yes 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. Pl Aee check ONE of the following:
p' Myproperty 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 water conserving plumbing fixtures com ly with the re I irements as indicated in the
table on the following page.
Owner or Owner Agent's Signature:,.;, Date:Lar /
Upon completing and signing this Uertilicate, please return it to the building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
fCVPE.RT'IN, O
PURPOSE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 o building(cDcupertino.org
1�0 r �: l 5)? o) 9c)
PERMIT CANNOT DE F'INALED AND CO'vIu'LETED ITNTIL
THIS CERTIFICATE
IIAS BEENiGlr .AND U 0ED TO TAE BUILDING -DIVISION
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 I
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 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 the terms and conditions of this statement
alnel-Agenf7s?-Name:
Si ndfare. 'Date 3fsr.�.
C[Facto� N e:
sigaare..................... .............. ........ ........................ Ltc:?.............................. ......Date': ...................
Smoke and CO form.doc remised 03/18/14
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 o building(cDcupertino.org )5110/A40
PROJECT ADDRESSy� I t43 C�
P j .
APN
OWNER NAME�- '� 1
PHONE _- w oqq
E --MAIL
STREET DRgE�SS
31 0 �� -
CITY, STATE, ZIP �;
C-P�.� _ C— E
FAX
CONTACT NAME Marjan Javanmard
PHONE650.477.6430 E-MAILmjavanmard@solarcity.com
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR M CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMESolarCity Corporation
LICENSENUMBER888104
LICENSE TYPE C10
BUS. LIC #200400`-F0
COMPANY NAMESolarCity Corporation
E-MAILmjavanmard@solarcity..com
FAX
STREET ADDRESS 391 Foster City Blvd
CITY, STATE, ZIP Foster City, CA 94404
PHONE650.477.6430
ARCHITECT/ENGINEER NAME
F7777BER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF Y1 SFD Or Duplex ❑ MultI-Famtly
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
4LAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
T TAL VALUATION:
DESCRIPTION OF WORK
Installation (31 ) rooftop flush mounted solar panel ( 6) kW
IVED BY: /
F
By my signature below, I certify to each of the following: la e prop owner 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 e rea t Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. r representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: _ Date:
SUPPL ME PSL INFORMATION REQUIRED
OFFICE USE ONLY
OVER-THE-COUNTER
F
❑ ,EXPRESS
U
U
W
x
❑ STANDARD
U
a
-
❑ LARGE
F
❑ MAJOR
PVApp_201 I. doc revised 03/16/11
CITY OF CUPERTINO
WN FEE ESTIMATOR — BUILDING DIVISION
19
ADDRESS: 21438 Krzich PI
DATE: 11/25/2015
REVIEWED BY: Sean
APN:
BP#:
`VALUATION:
1$18,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0hrs
PENTAMATION SOLAR -RES
PERMIT TYPE:
woRK
Installation of roof mounted solar 31 modules 8.06k
SCOPE
$0.00
Ocher JVeeh.7msp
h4ech. ilsz�. F: r .
I'�::4Y01 F1. 1�;C Di Check
d''hwm.rel, Pc'!'r7iD? Fee:
Ort z r Phpt ,-b InSLJ•
phv,ib. lras•!;. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). !hese fees are based on the nreliminary information available and are only an estimate. Contact the Deot for addn'l info.
FEE ITEMS (l,ee Resolution .I I-053 Fff 7/1/I32
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$236.00
Alternative Energy System
IPHOTO7REs Photovoltaic System
Suppl. PC Fee: (E) Reg. 0 OT
0.0hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee G Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
L.`onstruction
11c1lninistralive Fee:
O
Work Without Permit? 0 Yes (D No
$0.00
Advanced Plannin-Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
7P•aveu Documentafidn Fees:
Strong Motion Fee: IBSEISMICR
$2.34
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS ;;
$3.34
$236.00Y�TUTAL
.. FEE
$239.34
Revised: 10/01/2015