B-2016-2881 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2881
10397 PALO VISTA RD CUPERTINO,CA 95014-2714(357 03 027) SLINGSHOT POWER
INC
LOS ALTOS,CA 94022
OWNER'S NAME; CHANG GEORGE CHIA-JUNGAND CHUNG SUK-YEE TR DATE ISSUED:10/07/2016
OWNER'S PHONE:206-910-4185 PHONE NO:(650)308-9055
LICENSED COINTR A CTOR'S DECLARATION ATION BUILDING PERMIT INFO:
License Class C10C46 Lie.#984488
Contractor SLINGSHOT POWER INC Date 06/30/2017 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:
(1) 15 PANEL ROOF MOUNTED PV SYSTEM(2 ARRAYS)(5.03kw)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REDUCE NUMBERS OF PANELS TO 14(4.69kW)-ISSUED
1. 1 have and will maintain a certificate of consent to self-insure for Worker's 10/10/2016
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:$30000.00
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 357 03 027
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 D INSPECTION.
Signature'/ ! Date 10/10/2016 Issued by:MELISSA /
Date: 10/07/2016 A
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. I,as owner of the property,or my employees with wages as their sole installed without fust 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&Professions Code). Date:10/10/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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 a9 ent
APPLICANT CERTIFICATION Date: 10/10/2016
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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 10/10/2016 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMIENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,'CA 95014-3255
r
CUFRi tNQ (408)777-3228 FAX(408)777-3333• build ingCcDcuDertinO.org
❑NE-1W CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI LZ—REVISION/DEFERRED ORIGIN\?AL PERMIT ft
PROJECT ADDRESS \ 5q7 a(6 01 \ I APN r
OWNER e.0�`.1� PHOITE;k?,
STREET.ADDRESS I CITY,STATE;ZIP I FAX
CONTACT\AME �V/ 1 T PHO\T
STREET ADDRESS !.. CITY;STATE,ZIP � _ FAX
OWNER ❑ OWINZtR-BUTTDER ❑ U9,NTERAGENT ❑ COTTRACTOR ❑C0\7RACTORAGENT ❑ ARCHITECT ❑ENGNEER ❑ DEVELOPER ❑'TE1vA'\T
CONTRACTOR NAME'5(
LICEN'SEI\'Ljh6BER� � LICENSE TYPE e BUS.LIC
ll. ��#
f
COMP.ANYNAME E-MAIL FAX
STREET ADDRESSP CITY,STATE;ZIP PHO\E
.4RCHITECT/E1NGII\TER NAME LICENSE NUI,4BER G BUS.LIC
CONTAW. NAMM E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP I PHONE
DESCRIPTION OF WORK i VW W& r
0 W
EXISTING USE PROPOSED USE CONST R T1PE r STORIEST
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR I. DEMO TOTAL
AREA AREA AREA 1`TETAREA
BATHROOM - KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH.AREd DECK AREA TOTAL DECKTORCH ARLA I GARAGE AREA; MDETACH
',. ❑ATTACH
D\\'ELLNG UI\'ITS: IS A SECOND LiKIT ❑YES SECOND STORY ❑YES
BEING ADDED? [3"'0 ADDITION? ❑NO
PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES
❑ ❑ - _ .
PLA.2Q\T\GA = ❑
PPLNO PL.ANNNGAPPROVAL LETTER EICHLERHOME? ❑ TOTALVALUATION:
NO ' _
By my signature below,I certify to each of the following: I arm the property owner or authorized age property owner's behalf. I have read this`
application and the information I have provided is correct. I have read the Description ofWork 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 inspection purposes.
SianatureofAppiicantlAgen `t: ! � � Date: otlln C '
HECK
SUPPLEMENTAL LNTFORMATIONT REQUIRED
CTYPE
New SFD or Multifamily dwellings: Apply for demolition pennit for � r
- ^� O\ER THE COt�\TER I] BIIILDING
existing building s). Demolition permit is required prior to Issuance of building N.
a
permit for new building. I� EiPxEss � � PLAR\L\GPLA r RE\IE\\
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I] STANDARD � � L� PLBLIc\�oRl�s k
tonin if any Hazardous Material are being used as part of this project. y
LARGE FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to � AL470R T � SARIS�Rl SER ERDI�TRICT
submittal of Building Permit application.
G�� � Bld&Ipp 2011.doc revised 06/2I/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2881
10397 PALO VISTA RD CUPERTINO,CA 95014-2714(357 03 027) SLINGSHOT POWER
INC
LOS ALTOS,CA 94022
OWNER'S NAME: CHANG GEORGE CHIA-JUNG AND CHUNG SUK-YEE TR DATE ISSUED:10/07/2016
OWNER'S PHONE:206-910-4185 PHONE NO:(650)308-9055
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#984488
Contractor SLINGSHOT POWER INC Date 06/30/2017 X BLDG _ELECT _PLUMB
_
I hereby affirm that I am licensed under the provisions of!Chapter 9(commencing MECH X RESIDENTLAL_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(2 ARRAYS)5.03kw)
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.
z/f 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:$30000.00
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 357 03 027
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.
Signatu e' -------7;Z:® G�6 Date 10/07/2016 Issued A
Date:
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. 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/07/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
s. 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 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
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: 10/07/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct./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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 10/07/2016 professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228,FAX(408)777-3333•buildingP-cupertino.oCUPERTINO
rg
PROJECT ADDRESS U�] C`V APN#
OWNERNAME (-3^760 r o`ef \CJL�V t%G- '1 �✓� PHONIL �, �� ✓� _ V */
J E-MAIL
STREET ADDRESSLOS CITY,STATE,ZIP `
V FAX
CONTACT NAME �nom,�, '\ L� PH
STREET ADDRESS CITY,STATE,ZIP FAX
at
OWNER OWNER-BUILDER❑ OWNER-BUILDER ❑ OWNER AGENT El2 CONTRACTOR CON,TTRRACTlORAcGEN�Tp ElARCHITECT ❑'ENGINEER 1:1DEVELOPER 13TENANT
CONTRACTOR -fj LICENSE NUMBER vy S '/ (�(2El
LIC/SEaYPE BUS.LIC# S / 9
COMPANY NAME E-MAIL [C �d v FAX
STREET ADDRESS � I�J � CITY,STATE,ZIP/_ PHONE
ARCHITECT/ENGINEER NAME j LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
/ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
R__SOLAR PANELS
FOR SOLAR PANLLS. NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): e D TOTAL VALUATION: O�00
DESCRIPTION OF WORK Nfoe'1.1� 1 R � wy`.t/ � ! ` v V
It�151
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 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 t building construction. I authori7_e representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: F/' "� Date: 16171/ 6
SUPPLEMENTAL INFORMATION REQUIRED OFFICE usE ern ;
- � OYER=Z,`HE C;OU1sITER
w
EXPRES
' Sr �
CI STANDARD
i
LARGE:
a.
II MA-0
PVApp_2011.doc revised 03/16/11
SMOKE /,CARBON MONOXIDE ALARMS FiL7
�=
OWNER CERTIFICATE OF COMPLIANCE C
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 FAX(408)777-3333•buildinq(aD_cugertino.org
222 1' RMTxCAN1OTB + �7NALRD [1NTZI,THISC -RAH
PICATEHASBEl�l� _
��a SCO , -=�F�TED;�T(�NF rt �R'1�~I� 1R1�T1�>n►�O atlEi1,;�I�-
E
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 X X
the 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.
Iii 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 manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms specified below have been tested and are operational, as of the
date signed below. (`
Address: ``.al Permit No.
Specify Number of Alarms: 4 Smoke Alarms: I lay t #Carbon Monoxide Detectors:
f have read and agree to comply with the terms and conditions ofthis statement
Owner(or Owner Agent's)Name:
Signature........... .:....... .........:........ ...........................Date:
Contractor Name:
Signature..................................................................Lic.# ....................... ............Date:
................................
Smoke and CO form.doc revised 09/27116
WATER-CONSERVING PLUMBING FIXTURES .
OWNER CERTIFICATE OF COMPLIANCE � .
COMMUNITY DEVELOPMENT!C3Pir1ENT
DEPARTMENT901
•BUILDING DI S
Vl ION
U1'E11 T1Nt? 10300 TORRE AVENUE-CUPER-INO,CA 95014-3255
(48$)777-32228-FAX(408)777=3333-buildino(aDcuaertino oro
Owner Name r 1 K_� Permit NotA ,
Address I Ott
1. Is your real property a registered historical site?
❑ Yes CivilCode Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
l \
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.
No Go to Question 3.
3. Is water,service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do riot 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 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 Yes My real property is built and available for use or occupancy of 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:
t N My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January l,;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.
j 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
li plumbing 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 dates pecified 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 p" Dani
Upon completing and signing this Certi. e,please re rn' tot Building Division in order to final your building permit.
SB40'72015.doc revised 08/26/1'5