B-2016-2933 CITY OF CUPERTINO BUILDING PERMIT
BUH.DING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2933
21906 MONTE CT CUPERTINO,CA 95014-1144(,326 19 07$) SUNRUN
INSTALLATION
SERVICES INC
SAN LUIS OBISPO,CA
93401
OWNER'S NAME: ROWETT KEVIN J TRUSTEE&ET AL DATE ISSUED:10/18/2016
OWNER'S PHONE:408-666-1319 PRONE NO:(415)580-6900
LLCMSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C46 Lic.#750184
Contractor SUNRUN INSTALLATION SERVICES INC,Date 06/30/2018X BLDG X 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)34 PANEL(4 ARRAYS)ROOF MOUNTED PV SYSTEM(9.0 kW);
I hereby affirm under penalty of perjury one of the following two declarations: ADD(I)2 BREAKER PV SUB PANEL(100 AMP)
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.
'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:$18810.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
infoandstatelaws relating to agree t cmply with all city and county ordinances APN Number: Occupancy Type:
building construction,and hereby authorize 326 19 078
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 un rstands and will comply with all non-point
source regulation per the pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature- Date 10/18/2016 Issued by:ME IS AN
Date: 10/18/2016
I hereby affirm that am a mpt from the Contractor's License Law for one of the RE-ROOFS:
following two reaso 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 of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/18/2016
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 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
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 Munici e,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2550 ; 53 ,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:10/1812016 f
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 I hereby affirm that there is a construction le di 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. 97,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 Lenders 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.
Signature Date 10/18/2016 Licensed
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
CUPERTIN0 (408)777-3228• FAX(408)777-3333•buildindna.cupertino.org
PROJECT ADDRESS �f� APN R 3sy p
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OWNER NAME PHO'E
E-MAIL
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STRE ADDSS w CITY, STATE,ZIP 1 FAX
CONTACT NAME '
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ST ADDRES 8®G HONE CTTY, ATE,ZIP
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❑ OWNER ❑ OWNER-BUILDER ❑ OVINERAGENT 5CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGATEER ❑ DEVELOPER q❑ TENANT
CONTRACTORNAME LICENSE DUMBER LICENS fYPEp / BUS.LIC#
COMPANY NAME C'V/ ' E-MAIL G� 7
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STREET ADD ESS 2P r CITY,STATE,ZI4j '( PHONE
ARCHITECT/ENGINTTEER NAME LICENSE NUMBER BUS.LIC 0
COMPANY NAME E-MAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFII or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
10 SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FORSOL4RPAXELS. NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALU I N:
DESCRIPTION OF WORK `' e
Z
1F
By my signature below,I certify to each of the llowing: e property owner or authorized agent to act on th e er s be av d this
application and the information I have p Ovide is con t. ave ad the Description of Work and verify it' urate. I agree t mply with icable local
ordinances and state laws relating to bu' in st I a riz atives of Cupertino r the above-identi led prop or ins ection purposes.
Signature of Applicant/Agent; Date:
SUPPLEMENTAL ATION REQUIRED osn%Y .
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DocuS,ign Envelope ID:2D6C4B6C-8B16-4AE9-8FC5-C8BF859D5849
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING.DIVISION
CU PERTI hi0 10300 TORRE AVENUE-CUPERTINO,CA 95014--3255
(408)777-3228•FAX(40$)777-3333•buildinaacupertlno.ong
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PURPOSE
This affidavit is;,1 self-certification for the installation of all required Srnoke and Carbon Monoxide Alarms.for
Compliance with 2013 CRC Section R314,2018 C13C Sections 420.6 and,-19071,1 1.2 where no ulterior access for'
inspections are required.
GENERAL INFORMATION
xisting single-family and multi-family dwellings shall be provided With Smoke Alarms and Carbon
onoxide alarms. When the valuation of additions,alteratioi Ls,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 ?C X
j the bedroom(s)
On every,level of adwelling unit including basements X X
Witldn each sleeping room X
.Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
o not have an.attached garage. Carbon monoxide alarns combined with smoke alarms shall comply with
BC Section 420.6 and.shall be approved by the Office of the State Fire Marshal,
Power Supply:-In dwelling units withno co Yunercial power supply,alarm(s)may be solely battery operated.
in existing,dwelling units,alarms are permitted Lobe soler battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is to access by means of attic,basement or crawl
pace.Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2.An elect•ical.p.ermit.is required:for
larins which znustbe coiulectecl to elle building wiring.
i s owner of,the;above-referenced property,I hereby certify that the alann(s)referenced above has(ltave been
stalled in accordance with the manufacturer's instructions and in compliance with theCalifornia>3uildirtg
nd California Residential Codes.Thealarms specified below have been tested and are operational;as of the '
ate signed below,
ddress1 �' PerniitNo: i � '
pecity Number of Alarriis: 9 Smoke-Alarms: #f Carbon Monoxide Detectors:
L have read and agree o h the terms and conditions ofthis statement
Owner(or Owner Agent's)Name:
S�gnatur 114.d`r11!�f Dat
Kevin Rowett 10/24/2016 1 9:49 AM F
Contractor Name: -- kk
Signature Lica# [ .......Date: �� P
"'�.� ....,. PPP
6. ....
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Smoke and CO form.doc revisLd 09.%2711 Cr
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WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCEFIL7
Is6f."
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DWISION '� e
l UP1511TIN C� tg3{l0'TL RTE A' V�UE•CUPER"TiNO,CA 95014-3-255
(408)777-3228a FAX(408)777-3333 m buildicia�cupeati�an ora
Own Name \1 I j E Permit No
Address
I. I your real property a registered'historical site?
[I Yes Civil Code Sections 1 +01.1 through 1101:8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Egoes your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
p umbing,installation of water-conserving plumbing fixtures is not technically feasible?
E Yes Civil Code Sections 1101.1 through 1101.8 do riot 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. Isl water service permanently disconnected for your building?
j-Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
�: No-"e 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 Janu 1, 1994.
p Y— �Y
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. P1 ease 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
jplumbing fixtures to be replaced with water-conservmg plumbing fixtures.
I 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).
1 My property is a commercial real property. See Civil Code Section 1101.5.
tOn and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
1 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
r placed prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
d.rough 11011,the current California Plumbing Code and California Green Building Standards Code,and manufacturer"s
stallation requirements,and that the water-conserving plumbing,fixtures comply with the requirements,as indicated in the
table on the following page.
OwiIler or Owner Agent's Sigaaturerr e Date t ,
Upon completing and signing this Cis ate,please return it to the Building Division in order to final your building permit.
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