B-2016-2581 CITY OF CUPERTINO BUILDING PERMIT
BUHMINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2581
8183 HXANNISPORT DR CUPERTINO,CA 950144063(356 11 023) WEST COAST SOLAR;
INC
BRENTWOOD,CAA
94513
OWNER'S NAME: KIM EUNICE S DATE ISSUED:08/24/2016
OWNER'S PHONE;408-455-1139 PHONE NO:(925)516-3900
LICENSED COMMAS IMIS.DECLARAUOE BUILDING PERMIT INFO.
License Class C49 Lic.#905649 X BLDG _ELECT —PLUMB
Contractor WEST COAST SOLAR INC Date 12/31/2017 —
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing s
MECII 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)I I-PANEL ROOF MOUNTED PV SYSTEM(2.86)
1, 1 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.
76 2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of tho Labor Code,for the performance of the work for which this
permit is issued.
5q,Ft Floor Area: Valuation:$9000,00
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 APNN Number: occupancy Type:
and state laws relating to building construction,and hereby authorize 35611 023
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. WITHIN 180 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.
t
Signature l Cir Date 80/2412016 Issued by Kim Dunbar
Date 8 242016
OWNER-BUILDER.DECLARATIQP(
I hereby affirm that I am exempt from the Contractor's License Law for one of the R&ROOFS:
S_:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
s. I,as owner of the property,or my employees with wages as their sole inatalledwithout 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. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:80124/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
z, 1 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
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 compilanee with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which thispermit 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:80/24/2016
1 certify that I have read this application and state that the above Information Is CONS9'ULTION LENDING AGENC
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.3087,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, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITE TC :S aECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.16. I understand my plans shall be used as public records.
Licensed
Signature Date 801241201.Q Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 AE
CUPERTEt+lt7 (408)777-3228-FAX(408)777-3333•buildin cu ertinn.or
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PROJECT ADDRESS �.{^/ APN A
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OWNERNAME .t - PHONE71SS--_ 11.3 C} E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FAX
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CONTACT NAME � PHONE / �nf, E-MAI /
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STREET ADDRESS ,!3� CITY,STATE,ZIPS 6 ! FAX I� !,f
®.OWNER ❑OWNER-BUILDER ❑ OWNERAGENT Q.CONTRACTOR LCI CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TENANT
CONTRACCORNAME LICENSENUMBER LICENSE TYPE HUS "-
COMPANY NAME t✓sE-MAIL FAX
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STREET ADDRESS?-1 CITY,STATE ZIP PHONE
ARCHt'rECTtENGINEER NAME LICENSE NUMBER BUS.LIC 0
COMPANY NAME E-MAIL - FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF V(SFD or Duplex ❑ Multi-Family PROJECT IN WILOLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE"AREA ❑ Yes No FLOOD ZONE ❑ Yes 11 NO
❑SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WA'CER HEATING ❑ OTHER
FORSOLARYANEIS: NUMBEROFPANELS/UNITS:f I KILOWATTS(COMMERCIAL ONLY): 6- TOTALVALUATION:2 occ
DESCRIPTION OF WORK 5 ' SOIAr
V
IRE
CEIVED BY: -
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 Chris
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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant(Agent: - "d Date: Z/)��
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY, .
OVER.-THE-COUNTER
d EYPRES5 .
1❑ STANDAFtli
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❑ LARGE
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PVApp_201 Ldoc revised 03116111
SMOKE / CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION f
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333, building .cupertino.org
r� j Permit No.
Address l > P' 4 n a f #of Alarms Smoke
Carbon Monoxide:
PERMIT CANNOT SE FINALED AND COMPLETED ENTILTHI CERTIFIGATI
�A S BEEN�'I TD AND Rl I1RED�fl TSE I3IlILD1 DIVSi Dl�t
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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 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 SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s) --
On every level of a dwelling unit including basements 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 crawlspace.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..
t
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.
I have read and agree to compl with the terms and conditions of this statement c
Ow oNowner A ent's)Name: l`
sign .... ...........................................Date. ..... ..,......_..
Contractor Name:
Signature................................................... ....Lic.#......................................Date: ...................
Smoke and Cofoi-m.doe revised 03/18174
Ilan
WATER-CONSERVING PLUMBING 'FIXTURES If
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDINGDIVISION
CUP RTI O 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
( ) o.orq
Owner Name (��yry1 tr 0 f Permit No...-13-2 ?6-
Address
1
(408 777-3228-FAX 408 777-3333•building(a�cupertin
Address }S
1. Is your real property a registered historical site?
Yes Civil Code Sections 1101.1 through 110 1.8 do not apply. Skip the rest of the form and sign bottom of form.
jK 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?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
01 No Go to Question 3.
3, Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
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 H01.8 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).
I,as the owner or owner's agent of this property,certify under penalty of per ury'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 fix omply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: Date:
Upon completing and signing this Certificate,please re to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115