16010028-DPCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10720 ORLINE CT
CONTRACTOR: FREEDOM SOLAR INC
PERMIT NO: 16010028
OWNER'S NAME: LU GIN -PAO AND LIEN -SHUEN H
845 S MCGLINCY LN
DATE ISSUED: 01/05/2016
OWN 'S PHONE: 4082556096
CAMPBELL, CA 95008
PHONE NO: (408) 600 -8791
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
INSTALL 16 ROOF TOP, FLUSH MOUNTED PV MODULES
License Class Lic.'#�
(4.32KW)
n
FR` DC) ^7 ` o
Contractor V-VZ Date
I hereby affirm that I am licensed under the provision4 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: $20663
n
erformance of the work for which this permit is issued,
have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35922058.00
Occupancy Type:
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
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 ASST INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
; fG
granting ofthis permit. Additionally, the applicant understands and will compl
Date.
with all non -point sour regul ns per the Cupertino Municipal Code, Section
9.18.
RE- ROOFS:
Signature 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.
El 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
1, 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 (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. 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
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 ofthe work for which this permit is issued.
will maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 2 25 3 , and 25534.
permit is issued.
Owner or authorized agent: Date:
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 ofexemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
1 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
Lender's Address
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 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 APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buIIding(a)_cupegbg g[g1�olod20
AE
PROJECT ADDRESS
D °� n O �n U` t4 f �,
APN # j 5 9 „
7- �i , o -"
t
OWNER NAME LVc'�
`
PHONE �_z6,5_ Z�;TMAIL
STREET ADDRESS
/� T
tJl^
CITY, STATE, ZIP^ W 1 4h z
CONTACT NAME �(,
�/� u
PHONE E -MAIL
STREET ADDRESS �
i
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR Q CONTRACTOR AGENT ❑ ARCHITECT
❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # 37
COMPANY NAME r n
E -MAIL
Yt
F
STREET ADDRESS _ _ ,/
lK-
CITY, STATE, Z,II''
PHO 0
fW_I
/LIC
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS..r #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ® SFD or Duplex ❑ Multi - Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes [)a No
PROJECT IN
FLOOD ZONE ❑ Yes N No
W SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION 7
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS., NUMBER OF PANELSIIINITS: Q H IOLOWATTS: 1
/ I /V
TOTAL VALUATIO p0
144) UZI
DESCRIPTION OF WORK I�
By my signature below, I certify to each of the following: I an the property 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 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relati g to building construction. I authorize r sen lives of Cupertino to enter the above -i entified property for inspection purposes.
Signature of Applicant/Agent: Date: Z '—
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
w.
❑ OVER - THE - COUNTER
o,
F
❑ EXPRESS
U
❑ STANDARD
E�
Il LARGE.
❑ ` MAJOR
PVApp_2012. doc revised 06120112
W.0 CITY OF CUPERTINO
{, FEE ESTIMATOR — BUILDING DIVISION
4R,
ADDRESS: 10720 ORLINE CT
DATE: 01/05/2016
REVIEWED BY: NIELISSA
APN: 359 22 058
BP #:
*VALUATION:
1$20,663
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
hrs
PENTAMATION SOLAR -RE
PERMIT TYPE:
WORK
INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES 4.32k
SCOPE
4R,
x '
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 .9
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
.`I r7:'.i )::3'rr
Suppl. PC Fee: (D Reg. C) OT
0,0
hrs
$0.00
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 onlv an estimate. Contact the Deot for addn'l info.
FEE ITEMS (Fee Resolution 11 -033 Eff, 7/U13'
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 .9
$236.00
Alternative Energy System
IPHOTOVRES Photovoltaic System
Suppl. PC Fee: (D Reg. C) OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
t."Onsit-uction Klx:
t.It1fYd1F1t:Sfi ' fdlll'c C?:
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
,
7'iw" l 11 c.'.S:
Strom Motion Fee: IBSEISMICR
$2.69
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
o.. SITBTOTALS =
$3.69
$236.00
;
Fr(_ 91 1 WATER - CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE .
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
PER I!'DF� 1 0 o l 10300 TORRE AVENUE • CUPERTINO, CA 05014 -3255
C t)
(408) 777 -3228 o FAX (408) 777 -3333
Owner Name :..! — A4 ,o 1 /, 4 /_
Address /,P 0 129 L M40- t 'A fo �eey 44
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
A 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 form and sign bottom of form.
,I No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.I through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
A No Go 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 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).
w
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 manufacturer's
installation requirements, and that the water- conserving plumbing fixtures comply with the requirements as indicated in the
table on the followintz Dane. _ _ n
I Owner or Owner Agent's Signature: / 4( „ i Date: ' I
Upon completing and signing this Certificate, please re it to the Building Division in order to final your building permit.
SB407 2015.doc revised 0826115
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE MC
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CUPERTINO 10300TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 • buiIdinq(@cuj)ertln0 -orq
Pcr-Qniit RTO_ l�e c5'100 71'-,
Address 111
PERTMIT CANNOT BE FINALED AND COMPLETED i1NTIL. THIS CERTIFICATE
_I MS BEEN S IGNEg AND RLT_Lr UM- TO THE BUILDING IDIWSION
PPIRPOSIE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314, 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 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 agree to cornp!y with the terms and conditions of this statement
O�+ner (o "r Owner Agents) Name:
A
LCSi
nature........... � ................ ...... ......................... ............. t] ate: .............. .....
Contractor Na e:
(,P-72- ... Date : A(.� 1�0
Smoke and CO form.doc remised 03118114
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