B-2016-2768 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2768
1041 WEST HILL CT CUPERTINO,CA 95014-5063(362 27 048) SANTA CRUZ
WESTSIDE ELECTRIC,
INC
SANTA CRUZ,CA
95060
OWNER'S NAME: KARANDIKARASHISHKAND PATHIAKDEEPALI DATE ISSUED:09/21/2016
OWNER'S PHONE:408-326-2940
PHONE NO:(831)469-8888
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-LQ Lic.#846294
Contractor SANTA CRU7 WESTSIDF Q FCTRIQ INC Date 04/30/2017 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:
(N)21-PANEL(3 SEPERATE ARRAYS)ROOF MOUNTED PV SYSTEM
I hereby affirm under penalty of perjury one of the following two declarations: (6.3 KW)
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.
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:$22050.00
APPLICANT CERTIFICATION
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 362 27 048
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 all
this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and.will comply with all non-point
source regulations per the C pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
i
Signature Date 9-21-2016 Issued by:Kim Dunbar
Date:09/21/2016
O R-B 1ILDER 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. 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:9-21=2016
I hereby affirm under penalty of perjury one of the following three declarations: AT=T•ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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
a. I certify that in the performance of the work for which this permit is issued,I Health&c 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,9hapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 255 512593" 534,----
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9-21-2016
1 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 ARCHIIECTIS DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 9-21-2016 Licensed
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPER'E INO (408)777-3228-FAX(408)777-3333-_building 5cupertino.org
PROJECT ADDRESS
1041 West Hill Court Cupertino 95014, APN# 362-270-48
oWNERNAMEAshish Karandikar PHONE 408-326-2940
E-MAIL
STREET ADDRESS CITY,STATE,ZIP FA
Same as above
t. CONTACT NAME Krlstl CaS$etta PHONE
831-226-9363 E kcassetta@sandbarsc.com
STREET ADDRESS CTTY,STATE ZIP FAX
2119 Delaware Avenue M Santa Cruz Ca 95060 831-515-5098
OWNER. ❑. OWNER-BuiLDER ❑ OWNERAGENT Id CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC -
Sandbar 846294 C-10
MPANY AME _
%anta eruz Westside Electric dba Sandbar E kcassetta sandbarsc.com FAX 831-515-5098
STREET ADDRESS CITY,STATE,ZIP PHONE
2119 Delaware Avenue Santa Cruz Ca 95060 831-469-8888
ARCHITECTMNGINEER NAME Sungevity
LICENSE NUMBER BUS.LIC#
COMPANY NAME EMAIL FAX _
Jeramiah-jdean@sungevity.com
STREET ADDRESS CITY,STATE,ZIP PHONE
66 Franklin Street Ste.310 Oakland CA 94607
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN wILDLAND. PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes X No FLOOD zoNE ❑ Yes ❑ No
SOLAR PANELS. E3ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER IMATING ❑ OTHER:. $22,050
FOR SOLAR PAAELS: NUMBER OF PANELSIUNITS: KILOWATTS j TOTAL VALUATION:
DESCRIPTION OF WORK
Installation of a 6.3kw grid tied photovoltaic solar array roof mount
RECEI BY•
By my signature below,I certify to each o following: I am the property owner or authorized agent to act on the pr perty owner's behalf I have read this
application and the information I e p v' e i co ec I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati to b ilding o t' . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 9/21/16
PLEMENTAL INFORMATION REQUIRED aTc us .oNLY,
0ONE THE(COUNTER
k STV-MARb
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..;. `.. 0 MAJOR'
$VApp_2011.doc revised 03/16111
SMOKE_ ARBON MONOXIDEALA
OWNER _ TIFICAT F COMPLIANCE
COMM UIIIITY'DEVELOPMENT DEPARTMENT-BUILDING DIVISION ..
10300 TORRE AVENUE"•CUPERTINO,CA 95014-3255'
UP TINT . .
(408)777-3228. FAX(408)777-3333,_building(o)cupertino orci
s Permit No. B-2016-2768
Address 1041 West Hill Court Cupertino 950.14 , #of AlarmsSmoke: Carbon Monoxid
3?ERM11I CANNOT BE 3<IIVALED AND COMWIGETEID UNTIL
THIS CERTIFICATE
HATS.BEEN .i �+ A1VI)�F�T�t1Rl�F�.TQ�'I'H�$LTILY➢Ii�tG I2I�IS`��DN
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 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 SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On e ,ery level of a dwelling unit-including basements X X
Within each sleeping room T 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 8314 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 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 comply with the terms and conditions of this statement
O�wner9(or Owner Agent's)Name:`,,
Signature. ........ .........Date: �a�' .�..�.I
Contractor Name: -
tz c Si nature.... Lic# Date:
Smoke and CO form.doc remised 03118114
WATER-CONSERVING PLUMBING I T S
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION!'
P R`INO 10300 TORRE AVENUE CUPERTINO,`CA 95014-3255
(408)777-3228 a FAX(408)777-3333 m buildiriggeupertino.org-
Owner,Narne Pe-.n-nit No n nl h 76f3
Address J 041 West Hill Court Cupertino 95014 '
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 forin"and sign bottom of form.
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-conseiving plumbing factures isnot technically feasible?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.w
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
Ilk No Go to Question 3.
3. Is water service permanently disconnected for your building?'
❑ Yes Civil Code Sections-1 101.1 through 1101.8 do not apply. Skip the rest of tl e.fonn and sign bottom of form.
,Pk 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 fowl.
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 Teal property. See Civil Code Section 1101.4.
On and after January 1, 2014,building'alterations or improvements shall require all non-corripliant 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).
El My property is a ntultifantily residential real property. See Civil Code Section 1101.5.
On and afterjanuary 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).
Myproperty is a contntercial zeal 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
plurubing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
1,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-conseiving 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 thew er-eoinserviiigplu robing fixtures comply with the r equireinents as indicated in:the
table on the following page.
Owner or Owner Agent's Signature: ' Date: tt6
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08126115