B-2016-2927CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
7464 DUMAS DR CUPERTINO, CA950I4-4353 (359 26 013)
CONTRACTOR:
SUNRUN
PERMIT NO: B-2016-2927
INSTALLATION
SERVICES INC
SAN LUIS OBISPO,. CA
93401
OWNS WS NAME: VAN DUSEN MELVIN D
DAT ISSUED: 10/1712016
OWMR'S PHONE: 408=5961976
ONE NO; (413}.380.6900
LICENSED CONTRA.=!5.13ECLARAnQN—
BUIL,DINGPE INFO' "
License Class CC4 tic. #750184
Contractor EUNRUN INSTALLATION TION RVI ES INC Date 06/3012018
X BLDG CT _ LTJMB
T Hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH.. RESIDE _ GON1AWRCIAL
with Section 7000) of Division 3 of the Busine. ss & Professions Code and that my
license is in full force and effect.
JOB Sc TION:
I hereby affirm under penalty of perjury one of the following two declarations:
2-PANE OF TED PV SYSTEM 0.1 KW)
?. I have and willmaintain 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 'I'have and will maintain Worker's Compensation Insurance, as provided f by
Section 3700 of the Labor Code, for the performance of the work for w " h this
permit is issued,
Sq tFioo„ :
Valuation. $64700
AFPLICALNT CERTIFICATIOPi
certify that i have read this application and state that the above.
information is correct. I agree to comply with all. city and county ord' antes
iY um ere
Occupancy Type:
and state laws relating, to building construction, and hereby authq ze
359 2
representatives of this city to enter upon .the above mentioned operty for
inspection purposes. (We) agree to save indemnify and keep armless the
City of Cupertino against liabilities, judgments, costs, and a arises i
PERMIT.EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granti g of this em
Additionally, the applicant understands and will comply h all non-p int
'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulatio s per f' a Cupertino MuNcipal Code, action 0.1 a;
180 DAYS FROM LAST CALLED INSPECTION-
Signature Date 10/1712016
Issued by: Kim Dunbar
Date: 10/17/2016
I hereby affirm that am exempt from the . ntractor's License Law for one of the
following two reasons:
RF ROOFS:
. All roofs shall be inspected prior to any roofing material being installed. If a roof is
;. I, as owner of the property, or employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the wor and the structure is not intended or offered for
inspection. .
sale (Sec.7044, Business & , ofessions Code)
2. I, as owner of the property exclusively contracting with licensed
Signature of Applicant
contractors to construct a project (See.7044,.Business & Professions Code).
Date: 10/17/2016
I hereby affirm under penalty perjury one of the following three declamations:
AL • HOOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will ma' in a Certificate. ofConsent to self-insure for Worker's
Compensation, as ovided for by Section 3700 of the Labor Code, for the
"M1'ATERIALS
performance of . work for which this Permit is issued
z. I have and will aintain Worker's Compensation Insurance, as provided for by
HAZARDOUS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 37.00` the Labor Code, for the performance of the work for which this
California Health & SafetyCode, Sections 25505, 25533, and 25534. Lwill
with the Cupertino Municipal Code, Chapter 9.12 and th
maintain compliancee
permit is is ed.
Health &Safety .Code, Section 25532(x) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 I�ealfh &Safety Cod Se 'ons 2 505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
f
be. deemed revoked.
Owner or authorized agent, J-
APFLICANT CERTIFICATION
Date: 19/17!2016. Lfi
TION AGENCY
1 certify that I have read this application. and state that the above information is
FnN TR L ING
I hereby affirm that there is a construcf lending agency for the performance.
correct. I agree to comply with all city and county ordinancesandstate laws
of work's for which this permit is issue Sec. 3057, Civ C.).
relating to building construction, and hereby authorize representatives city
Lender's Name
/o��fthis
to. enter upon the above. mentioned property for inspection purposes. (We) agree
t6 save indemnify and keep harmless the City of Cupertino against liabilities, I
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
CT,c D ARATION
and will comply with all non-point source regulations per the Cupertino Municipal
ARCI .CF
1 understand my plans shalt be used as public records,
Code, Section S.18.
Licensed
Signature Date 10117/2016
- ALTERNATIVE ENERGY .PERMIT APPLICATION
12J, r COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
i
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO (408) 777=3228 • FAX (408) 777-3333 , buiiding cDcupertino.org
PROJECT ADDRESS :� � � �
�
APN # 13
OWNERN
E-MAIL
STREETADDRESS i�
K-[
CTTY ST TE ZIP. //� FAX A�41
7
CONTACT NAME
• � A./
rx E f��3
1. rL
STREET D1 S 4 f/`
NATE
13 OWNER ❑ OWNER-BUIMER ❑ OWNERAGENT L*TCpNTRACTOR ❑ DNTRACTORAGENT ARCHITECTABNartTFR, 0 DEVE1oPER Q j NANT
CONTRACTOR NAME
LICENSED ER
LI SE TYP
L
BUS. LIC
COMPANY NAME
MAIL
FAX
SPREETADDRESS
U0.: , 4 1�
CITY STATE
SJ" /
H NE
7V&
ARCHITECTIENGINBER NAME
LICENSE NUMBER
BUS. LIC .9
COM? ANY NAME
E-MAIL
Fi1X
STREET ADDRESS
,STATE, ZIP \
PHONE
C3�k'D orDuplex ' it . y
❑ Multi -F -
USE OFI
STRUCTURE: I-]Coriiinercial
PROCT Tri VJ1
URB INTERFACE A ❑ Yes ❑
PROJECT IN
FLOOD ZONT_ o Yes p No
• SOLAR PANELS
❑ ELECTRIC V HICLE CHARGING STATION
SOLAR WATER I -MATING
Q OTHER:
FORSOLARPANELS: NUMHEROFPANELS TS: t
KILO S . MNMRCIALONLi): 3.1k ➢
TOTALVALII
' ..
DESCRlPTiOA OF WORK
S� l
wwF�
WIN 1`10=0000
erty owner or authorized went to act on the property owner's behalf. I have read this
By my signature below certify to each of the fallowing: I�h�ad
application and the in rmation I have provi d is con t ' e Description ofWork and verify it is accurate. I agree to complywith all applicable local
ordinances and state aws relating to buildi cons n,presentatives of Cupertino to enter the above igen ' tcd prop r�for inspection purposes.
Signature ofAppli anUAgent; Date: oI/til
SUP MENT ORMATION REQUIRED
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F114pp 201Ldocrevised 03116111
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2927
7464 DUMAS DR CUPERTINO, CA 950144353 (359 26 013) �SUNIZUN
INSTALLATION
SERVICES INC
SAN LUIS OBISPO, CA
93401
OWNER'S NAME: VAN DUSEN MELVIN D
(DATE ISSUED: 10/17/2016
I OWNER'S PHONE: 408-5961976 1 1PHONE NO: (415) 580-6900
LICENSED CONTRACTOR'S TOR'S DECI AD ATION
License Class C46 Lip. #750184
Contractor SUN -RUN INSTALLATION SERVICES INC Date 06/30/2098
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:
1. I have and will maintain a certificate of consent to self -insure for Worker's
BUILDING PERMIT INFO -
X_ BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(1) 12 -PANEL ROOF MOUNTED PV SYSTEM (3.1 KW)
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. Sq. Ft Floor Area: Valuation: $6479.00
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
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 regulatiops per t�e Cupertino Municipal Code, Section 9.18,
Date 10/17/2016
"N Number:I Occupancy Type:
359 26 013
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 10/17/2016
I hereby affirm that(ram 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
s. 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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/17/2016
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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. 1 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.
Date 10/17/2016
11 A 11
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 Cod Se 'ons 2 505, 25533, and 25534.
Owner or authorized agent:
Date: 10/17/2016 I
CONSTRUCTION LINGAGENCY
hereby affirm that there is a construct' lending agency for the performance
of work's for which this permit is issue' Sec. 3097, Civ C.)
Lender's Name
Lenders Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO
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.orr
PROJECT ADDRESS i)
APN o13
13
OWNERNAAPHONE
y / E-MAIL
STREET ADDRESS
CITY ST TE ZIP FAX
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CONTACT NAME
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STREET DJS5_ , f
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C TATE
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OWNER ❑ OWNER-BLMMER ❑ OWNER AGENT P COI"ICTOR. ❑ CONI'RACTORAGENT ❑' ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME � g
COMPANY NAME
LIC ENSENUM ER LICE ETYP
E-MAIL
BUS. LIC # `24?
FAX
STREET ADDRESS/�
12a 600 7-,WvV
CITY STATE ZI
31
AAA
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC �i
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ' C FD Or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes p No
"SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PAA 'ELS. NUMBER OF PANELS/UNITS:
KILOWATTS (COM\gRCIAL ONLY):
TOTAL VALUATION:
DESCRIPTION OF WORK k.A
s -
t
RECEIVED B� 4 ; i{ _...
By my signature below, I certify to each of the following: I 9the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provi dis corre�t h e read the Description of Work and verify= it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to buildi const n. th epresentatives of Cupertino to enter the above-identifiedfprop for inspection purposes.
Signature of Applicant/Agent: Date: G / 7 <
SUP MENT ORMATION REQUIREDY
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PVApp_201 Ldoc revised 03/16/11