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B-2016-2119 CITY OF CUPERTINO BUILDING PERMIT BUR DING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2119 911T ERTYCT CUPERTINO,CA 95014-4018(356 11 063) WEST COAST SOLAR INC BRENTWOOD,CA 94513 OWNER'S NAME: SYMONS JULIE A TRUSTEE DATE ISSUED:06/13/2016 OWNER'S PHONE:408-497-3805 PHONE NO:(925)516-3900 T ICEN ED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ROOFING Lic.#908 Contractor WEST COAST SOLAR INC Date 12/31/2017 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that 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. JOB DESCRIPTION: (N)14 PANEL ROOF-MOUNTED PV SYSTEM(3.64 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. 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. Sq.Ft Floor Area: Valuation:$12000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 11 063 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 PERMIT EXPIRES,IF WORK IS NOT STARTED may accrue against said Ci in consequence of the granting of this permit. y g �' q WITHIN 186-DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6/13/2016 Issued by:Abby Ayende Date:06/13/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the _ RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 without first obtaining an inspection,I agree to remove all new materials for i. I,as owner of the property,or my employees with wages as their sole installed wi g p gr compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) i 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/13/201 i 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 Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. 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 the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION , Date:6/13/2016 i certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) 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,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/13/2016 Professional ... ... ... .. .... CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (�}; (408)777-3228•FAX(408)777-3333•building -cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISIOON/Dp))E��FERRED ORIGINAL PERMIT# '5V PROJECT ADDRESS ��f%ZT C/ APN# - k 1IJGP5 OWNER NAME L/£ �d� n PHONEE-MAIL V 5 _?S-0 STREET ADDRESSJ CITY,STATE,ZIP FAX CIT CONTACT NAME ONE E-MAIL STREET ADDRESS C TY,STATE,ZIP F zlss £lJ��tizs a T� ,� ��.//�v� 13 OWNER ❑ OWNER-BUII.DER ❑ OWNER AGENT 11 CONTRACTOR 2 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONT CTOR NA�ME ��J� 1 LICENSE NUMBER ^ LICNSE TYPE BUS.LIC# COM ANY NAM j// �f VE-MAIL 5F 7 FAX L�(� T msr -� �Xtl__Ilr it /4'vIJE STREET ADDRESS CITY,STATE,ZIP PHONE ur= n _S 5-1L - 390 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP // PHONE DESCRIPTION OF WORK / (p ,-yy r1v41,</1_T:12 r i— Day L L-S EXISTING-USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPF, OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC ED.BY. TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO (� e� OD By my signature below,I certify to each of the following: I am the property owner or authorized agent tolict onkhe 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 c nstruction. I authorize representatives of Cupertino to enter the above-identified property`for inspection purposes. Signature of Applicant/Agent: Date: / SUPPLEMENTAL IN ORM TI REQUIRED pLAN`CHECK TIPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for " ❑ OYER-THE-CO[JNTER ❑ BUILDING PLAN REVIEW 'existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs : Provide a completed Hazardous Materials Disclosure El STAN DARD ElPUBLIC woRxs ` fonn if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑y3NAJOR'X ❑ °sANITARY SEWER DTRIer submittal of Building Permit application. ❑`"ENVIRONMENTAL HEALTH. BldgApp_2011.doc revised 06/21/11 SMOKE I CARBON MONOME ALARMS OWNER CERTIFICATE OF COMPLIANCEail COMMUNITY DEVELOPMENT DEPARTMENT$BUILDING DIVISION CUPERTINO, 10300TORRE AVENUE.CUPERTINO,CA 3.5014-3255 (408)777-3228 FAX(408)777-3333-tuildingCa cupertino.orU; ` Permit No. �°. _ �. Address " f"`+`°"fie' ® e #of Alarms Smoke: Carbon Moi ioxide: Z PERMIT CANNOT BE FINALED AND COMPLETED UNTIL,THISCERTIFICAT HAS BEEN UR AND RETURNED TO THE BUII DIlVG DIVISION I PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxid Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interioi 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 twits exceeds $1000.00,CRC Section 8314 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 Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of,a dwelling unit induding basements X X Within each sleeping room X 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 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 batt 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 8314 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 h shave been installed in accordance with the manufacturer's instructions and in compliance with the Califo a Building and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agents)Name: c 3 I'Y� O Al Si nature.... ..... ......... Date: ................. Contractor Name: Signature-----------------....... .......................................lie.# .............................. Date Smoke and CO-form.d e revised 03118114 F ft ILE WATER-CONSERVING PLUMBING"FIXTURES OWNER:CERTIFICATEDF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION Eftrt 10300 TORRE AVENUE>C.IPERTINO,CA 95014-3255 CUP (40€)777-3228 a FAX 14031777-3333 o buildincgWcupgrt �jnp.qrq Owner Name 11'e- Permit No. Address 1_ k1_eC 1-. Is your real property a registered historical site? VN es Civil Code Sections 1101.1-through 1101.8 do not apply. Skip the rest of the form and sign bottom o form. o Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property c r its, plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. 0 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. "o Go to Question 3. 3. Is water service permanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through,110 1.8 do not apply. .Skip the rest of the form and sign bottom o f form. �To Go to Question 4. 4. Is your real property built and available for use or occupancy on orbefore January 1,1994?` No My real property is built and available for use or occupancy after January 1,.1994. �BB Civil Code Sections 1101,1 through 1101.8 do not apply. Skip the rest of the form and sign bottom f form. 1� es '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. �$V check ONE of the following: y 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 plumb g Mures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant oncompliant 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 110.1.5. 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 'r 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- co serving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improve eats): I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing i ixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code ectons 1101.1 through 110 1. the current California Plumbing Code and California Green Building Standards Code,and man facturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as ind sated in the table on the following page. Owner or Owner Agent's Signature: Date: 9 Upon completing and signing this C ate,please return it to the Building Division in order to final your building permit. SB4072015.d crevised 08126115