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B-2016-2586CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22545 SALEM AVE CUPERTINO, CA 95014-5648 12 098) CONTRACTOR: PERMIT NO: B-2016-2586 (342 SENDER SOLARIS CONSTRUCTION INC ALPINE, CA 91901 OWNER'S NAME: READY JAMES F AND YUMIKO M TRUSTEE DATE ISSUED: 08/25/2016 OWNER'S PHONE: 408-237-0372 PHONE NO: (619) 715-4054 BUILDING PERMIT INFO: LICENSED CONTRACTOR'S DECLARATION License Class ROOFING Lie. #B C10 Contractor SEMPER SOLARIS CONSTRUCTION INC Date 10/31/2016 X BLDG ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: (N) 16 -PANEL ROOF MOUNTED PV SYSTEM (5.52) 1. I have and will maintain acertificate of consent to self -insure for Worker's REV # I - SWAP PLANS TO MATCH SCOPE - ISSUED 10/10/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. Y z 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: $25000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 342 12 098 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 City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations� e'Cupertino Municipal Code, section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. SignDate 10/10/2016 Issued b3c D 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. 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 with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/10/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12'and 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 a. ent ;" ---= - APPLICANT CERTIFICATION Date: 10/10/2016 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. I understand my plans shall be used as public records. Licensed Signature Date 10/10/2016 Professional CUPER,TING'3 F 117\u COTS r, T T Ir T'TCIN GONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQ-cupertino_org F7 ATITITTT(1T.T AT TLD A-rin KT I a -i AC IJ "I B ldgApp_2 011. do c rerised 0612U11 PROTECT ADDRESS C��' g� ,>. §S�' Q� A IY (/ ' � A l/ 'L % APN r OW-NERNAME-� PHONE �E-i`ZAIL 2 � I ��6�)� �o,37 STREET ADDRESS r- G�a� C y�� CITY; STATE; ZIP , FAXU/, I r e -,-q t CONTACT NOJME d� /{ j�; I ` i� PHO ��7 � 2� - � E-MAIL STREETADDRESS CITY, STATE, ZIP ) , FAX ❑ om ER ❑ OwN-,R=BTT-DER ;' ❑ OV,•NERAGEN7 -Q/CONIR.4CTOR ❑ CONTRACTOR.AGENT ❑ ARCHITECT ❑ ENGNTER ❑ DEVELOPER ❑ Tnr .', T CONTRACTORNA-ME LICENSENTUNIBERLICENSETYPE �1� BUS. LIC= COWANTYl UIE E-A4AIL �y p FAX L-1 STR ET.ADDRESSCITY, l ow -�3C e4'00' c� STATE, ZIP C Cls PHONTE ARCHITECTIENGLnTEER NAAlE LICENSE \T131\IBER BUTS. LIC COMPANY NAA4E E-MAIL FAX STREET ADDRESS CITY, STATE, 7IP — I PHONT DESCRIPTION OF WORK deo Civ EXISTLNGUSE PROPOSED USE CONS.TR7YPE #STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG IMW FLOOR DENIO TOTAL AREA AREA AREA NET.AREA BATHROOM Krrr-HEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA POR7 DECK AREA TOTAL DECKPORCHAREA G.ARAGEARE0.: El DETACH ❑ ATTACH I DWELLNG L"QITS I5.4 SECOND UNIT ❑ -I-ES SECOND STORY ❑YES - - BEL*i•G.4DDED? ❑NTO ADDITION? ❑NO - PRE -APPLICATION. ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TA L VALUATION: PL.A.,NrNGAPPL_ E3 -NO PLA2\-\ N G APPROVAL LETTER EICHLERHOME.? El NO . -- zw 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 have read this application and the information I have proN!ided 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 relatingt bff nstructi ---Palft1horize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signatare of Applicant/Agent SUPPLEMENTAL INFORMATION REQUIRED Q r PL0.�CHECKTIPE,,` ROUTING SLIP , � ©� E12 THE Coi .TER � BitDING PL4_� REiZE� New SFD or Multifamily d -Wellings: Apply for demolition permit for existing building s). Demolition permit is required prior to issuance of building t Permit for new building.LK a EiPREss ❑ PL4\\L GPL�\ RE4IE\i Commercial Bldgs: Prop ide a completed Hazardous Materials Disclosure LJ STAID RD ti �rl�uc i\oRi`s 1 _ formn 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 h� submittal ofBurlding Permit application. WOR S4 �IT4R1 SE\VERDI�TRICT B ldgApp_2 011. do c rerised 0612U11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2586 22545 SALEM AVE CUPERTINO, CA 95014-5648 (342 12 098) SEWER SOLARIS CONSTRUCTION INC ALPINE, CA 91901' OWNER'S NAME: READY JAMES F AND YUMIKO M TRUSTEE I I DATE ISSUED: 08/25/2016 I OWNER'S PHONE: 408-237-0372 I I PHONE NO: (619) 715-4054 11111101 R R351 e ►I - s RRIONVATMUs . License Class B. C-10 Lie. 42ZB152 Contractor SEMPER SOLARIS CONSTRUCTION INC Date 10/31/2016 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: r. 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. 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; costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 08/25/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. I, as -owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 2. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 08/25/2016 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL, COMMERCIAL JOB DESCRIPTION: (1) 16 -PANEL ROOF MOUNTED PV SYSTEM (5.52) Ft Floor Area: I Valuation: $25000.00 APN Number: Occupancy Type: 34212 098 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Kim Dunbar RE -ROOFS: 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. Signature of Applicant: Date: 08/25/2016 COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 2553%3, and 25534., Owner or authorized agent: Date: 08/25/2016 CONSTRUCTION E I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building6beupertino.org CUPERTINO 5-S PROJECT ADDRESS „ v o APN# _ ✓• / PHONE y, OWNER NAME G� ��+ .EMAIL STREET ADDRESSy, C y� CTTY, _STATE, ZIP FAX C. LJ e CONTACT . PHON P' y y-? E-Ty�Ab 2- •' -;>, �I P,VApp_2011.docrevised 03116111 ,t C, DIN N FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT *(CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r ?� 6)BBER l CONItANAMEY E-MAIL FAX STREREET RESS e �C� CITY STATE;ZIP �.. �' �� G PHONE /4f) ARCHITECT/ENGINEER NAME LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD OT Duple% ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑. No ❑ SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: 4 �, DESCRIPTION OF WORKrlwzz �� � �^► . 'Z�' �7 k i/I P,VApp_2011.docrevised 03116111 ,t C, DIN N