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15120165-DPCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21580 EDWARD WAY CONTRACTOR: CLEAN SOLAR PERMIT NO: 15120165 OWNER'S NAME: BEYDA WILLIAM J AND CATHY S 1445 KOLL CIR STE 109 DATE ISSUED: 12/17/2015 OWNER'S PHONE: 650391 1906 SAN .LOSE, CA 95112 PHONE NO: (408) 217 -8876 I�. LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] INSTALL (N) ROOFTOP MOUNTED SOLAR PV - 23 PANELS (��y License Class Lic. # '210 9(1 % (7.94 KW) Contractor �i� Pti( Date 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. 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: $42164 performance of the work for which this permit is issued. 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 APN Number: 35618017.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 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 INSPEC7�6 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the '� I ?PULDNOW I gr anting of this permit. Additionally, the applicant understands and will comply Issued b y: Date: i with all non -point source g lations per the Cupertino Municipal Code, Section 9.18gRk� RE- ROOFS: Sign Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of.the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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(x) should I store or handle hazardous 1 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 Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino icipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 533, and 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ag Dater ( t permit is issued. . 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 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 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATICN COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingOcupertino.org 51 OnZ 00) 65 _ PROJECT ADDRESS APN R OWNERNAME I P ONE E -MAIL STREET ADDRESS CITY STATE, ZIP FAX CONTACT NAME - c � O }"' ^ t ( � � E42AIL aZILP. STREET D 'SS CITY TATS, OE� FAX.! -y 00.T�t ❑ O %VN7R- BUrLDER�❑ OW1��RAGENT N*IRACTOR ❑ CON'TiRACTORAGENI' ❑ ARCHITBI CT ❑ ENG- 1,7EER ❑ DF%SLOPER ❑ 7yNANT - CONIR1,CTORNAA4E ('Q,G LICENSE NLT4BE�r, 'ICENSETYP Bus. 'ICR t�► -� COMP L E-MAIL FAX TREET ADDRESS "n C TATS, ZIP - PHO7� ARCHITECT /ENGINEER N.A7,4B LICENSE NU1ABER I BUS. LIC R COMPANY NAME E -M.A1L FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF XSFD cr Duplex ❑ Multi - Family PROJECT IN WILDLANT) PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No -1P3CLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER DATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELSIUI\`ITS: KILOWATTS (COM.MIERCIALONLY): TOTAL VALUATIO ]� / DESCRIPTIONOF WORK -7 - .RECEIZ'ED �. By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property Cwner's behalf. I have read this application and the information I have provided is c -ct. I have read the Description of Work and verif, it is accurate. I agree to comply With all applicable local ordinances and state laws relating to building can I ion, I autho * e presentatives of Cupertino to enter the above - identified p ope;ty for inspection purposes. Si;natureofApplicant/Age : AA 64 qZ x Date: L 7,1\ S PLEA N L INTOR-NiATION REQUIRED _ 7xOF'FrC UsE0"LY �.R iOVERTI�COIJItZ'ER'' '� r; -� 4 S �❑ .EhPR1yS5.. - P = �- . s =� - _1 - - cTAJ�'DARD .-- u U.= Xc' SJ '- PV4pp_201l.doc revised 03116111 5 M�7, CITY OF CUPERTINO 1 1501,01-65 . FEE ESTIMATOR - BUILDING DIVISION iksLADDRESS: 21580 Edward Way DATE: 12/17/2015 REVIEWED BY: PAUL °<r�r'a. ?'t; •r,:'. _ ,' ;.,., APN: 356 18 017 BP #: "VALUATION: 1$42,164 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION SOLAR -RE PERMIT TYPE: WORK Install N rooftop mounted solar PV - 23 Panels 7.94 K SCOPE PME Plan Check: 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 preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS (Fec Resolution 1I -033 1ff 7/1/1:L FEE QTY /FEE MISC ITEMS °<r�r'a. ?'t; •r,:'. _ ,' ;.,., r'lalt "C5. I'r'; ..., i ? �. � . i>1 Pc. �'i�rr:!a ?• r. �. $0.00 ED Alternative Energy System iPi- 107ovRE'S Photovoltaic System Suppl. PC Fee: Q Reg. Q OT 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 preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS (Fec Resolution 1I -033 1ff 7/1/1:L FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System iPi- 107ovRE'S Photovoltaic System Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Perin it Fee: $0.00 Suppl. Insp. Fee.-(F) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? C) Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure Q i Stron)Z Motion Fee: iBSF_iSM /CR $5.48 Select an Administrative Item Blday Stds Commission Fee_ 1BCBSC $2.00 SU_BTOTAtiS: ° $7.48 $236.00 TOTAL :FEE: $243.48 Revised: 10/01/2015 CUPERTINO Address FI« SMOKE t CARBON MONOXIDE ALARMS,.. t-1 OWNER CERTIFICATE OF COMPLIANCE m� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 950143255 (408) 777 -3228 • FAX (408) 777 -3333 - buildino9icuoert1no.or9 aSgi� CJG(rpQ c��(_ lJ�%C/ 1 y►c `� - r#-OfAkn vAmdit k; P i_ S"12 D 1 Z,!;- PERMIT CANNOT BE FINALED AND COMPLETED UN"L: TADS CERTInCATE HAS BEE>K �,n�g A.N� $ TU:xHE;BUIGDINO pI�ISi4�1, 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 9072112 where no interior access for inspections are required. GL\-ERAL INFORNMATION 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 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 SMOKY ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedrooms X X On every level of a dwelling unit including basements X X Within each sleeping room I 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 manufacturers 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 aqee to cofrpY with the terms and condilfons aphis statement Owner (or Owner ft 5) (( c � 'r � Sb Mture .................... �...... ............................ ......_...._....._. 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