B-2016-2717 CITY OF CUPERTINO BUILDING PERMIT
BUILD INGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2717
21660 RAINBOW CT CUPERTINO,CA 95014-4829(366 38 006) RECTIFY LLC
j CAMPBELL,CA 95008
OWNER'S NAME: VAN BUREN DONALD P AND GREENIE LTRUSTEE DATE ISSUED:09/14/2016
OWNER'S PHONE:408-996-2619 PHONE NO:(835)573-2843
i
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CA Lic.#1014694
Contractor RECTIFY I I C Date 05/31/2018 Y 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)15-PANEL ROOF MOUNTED PV SYSTEM(7.23 KVO
i. 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.
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:$13612.00
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 . 366 38 006
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 per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature% � Y G _ - to 09/14/2016 Issued by:MELISSA NAME
Date:04/14/2016
OWNER-BIJILDERDECLARATTON -
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
i. I,
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 ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/14/2016
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 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
3. I 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/ �'G {
APPLICANT CERTIFICATION Date:09/14/2016
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. l understand my plans shall be used as public records.
Signature Date 09/14/2016 Licensed
Professional
ALTERNATIVE ENERGY 'PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333•building(a)-cupertino.org
CUPERTINO
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OWNER' ❑ OWNER-BUILDER" ❑. OWNERAGENT .� CONTRACTOR. ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONT CTOR NAME LICENSE NUS ER LICENSE TYPE BUS.LICft
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP - PHONE
USE OF Iig SED or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes R-No
IN SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: KILOWATTS(COOIEBCI®L ONLY): TOTAL VALUATION: y
Is 1' ¢
DESCRIPTION OF WORK L�y-G
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RECENED 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 h ve read this
application and the infonnation 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 b g constructi n..I utho ' e represe tives of Cupertino to enter the above-ide ttified p operty for inspection purposes.
Signature of Apphcant/Agent: Date: ®� 2-0
SUPPLEMENTAL INFORMATION REQUIRED
,OFFICE USE ONL,`Y
I I gyER-THE C9UNTER„
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MAJOR
PVApp 2011.doc revised 03116111
SMOKE / CARBONMONOXIDE ALARMS I
Im OWNER CERTIFICATE OF COMPLIANCEimo . o /
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(a-cupertino.org
aPermit oN _0 16 —X7..177
ddr-ess-- <#ofarms Smo e1 Carbon Monoxide
PERMIT CANNOT BE FINAL- ED AND COMPLETED-UNTIL THIS CERTIFICATE
t . HAS BEEN S 'rI AND R T T O THE SITIiDIVG bTVISTUN. a
PURPOSE
TI-ds 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 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 manufacbur er's in s trc'Ll onns ai'nd in compliance with the Callfomia Budding
and California Residential Codes.The alarms have been tested and are operational,as of the date signed
below.
1 have read and agree t om 1 with the terrps and conditions of this statement
vrner(or Qwner Agerr _Naini
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-Confrac or Name:
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Smoke and COforin.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES F I
OWNER CERTIFICATE OF COMPLIANCE � I
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
408j 777-3228•FAX(40%777-3 3.building atupertino.org
Owner Name6 o 0 a�C� `�6 re o i �o � Li re-_ el Permit No!:) RDl e f
Address d / O
1. Is your real property a registered Historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
i (K 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 110 1.1 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.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 K 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 110 1.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
i f Nr 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 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 following page.
Owner or Owner Agent's Signature= I Datie:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doe revised 08126115