B-2016-3019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3019
19765 AUBURN DR CUPERTINO,CA 95014-2413(316 32 008) SEMPER SOLARIS
CONSTRUCTION INC
EL CAJON,CA 92020
OWNER'S NAME: HUNG JUIPU AND HUANG SZU-I DATE ISSUED:11/01/2016
OWNER'S PHONE:408-515-7184 PHONE NO:(619)715-4054
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 B Lic.#978152
Contractor SEMPER SOLARIS CONSTRUCTION INC Date 10/31/2018 X 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:
INSTALL 9 PANEL ROOF MOUNTED PV SYSTEM(2.943kW);
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL(N)SUB PANEL(125 AMP)
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.
I have and will maintain Worker's Compensation Insurance,as provided for by
7 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$13200.00
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 316 32 008
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 ofthe hg of this permit.
itWITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with.all non-point
source regulations per the C •-rt' . unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION..
Signature' Date 11/01/2016 Issued by:MELI
Date: 11/01/2016
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
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:11/01/2016
I hereby affirm under penalty of perjury one of the following three declarations: A1,7,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. IL after making this certificate of will maintain compliance with the Cupertino Mricipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 5,25533,and 5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:.
APPLICANT CERTIFICATION Date:11/01/2016
I 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 enterupon 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'11/01/2016 Professional
k /Y ' ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONAE
-Ig�� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinglc�cupertino.orq
CUPERTINO
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' PROJECT ADDRESS l i •lam ✓ i1 p u.2A...) p ` APN# _3L .4 'i '� oc
OWNER NAME D 1 �® t"1�JL:/ PHONE eicsc875.C , N
a 'STREET ADDRESS ' ,� CITY STATE,ZIP
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CONTACT NAME ED -- PHONE E I
STREET ADDRESS �, CITY,STATE,ZIPFAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT A CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME _ LICENSE NUMBER ( LICENSE TYPE BUS.LIC#
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COMPANY NAMEEMAIL FAX
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STREET ADDRESS s�r CITY,STATE,ZIP s� PHONE r�
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
:
USE OF 0 SFD or Duplex CI Multi-Family PROJECT IN WILDLAND PROJECT 1N .
STRUCTURE: Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
1,,w SOLAR PANELS I ❑ ELECTRIC VEHICLE CHARGING STATION , ❑ SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: q f.'i 72081.-
DESCRIPTI,ON OF WORKe. ,� �"
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By my signature below,I certify to each of the following: I am the property owner or authorized agent o act on the prop- wner's u al£ I • 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 t. om. ^ii.all applicable local
ordinances and state laws relating to -`.in construction. _.uthorize representatives of Cupertino to enter the above-identified for inspection purposes.
Signature of Applicant/Agent: . _- - ----- Date: 1 1 // //
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY ,
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Pi/App 2011.doc revised 03/16/11
WATER-, ONSERVING PLUMBING FIXTURES 1\,
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# OWN-ERRTIFICATE OF COMPLIANCE
, i ,3 ,
commuNTy.EV PMENT DEPARTMENT.BUILDING DIVISION - IF °
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Permit NoLJ
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Address al- fiA ilt•4A
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1. Is you real property a registered historical sit -"
0 Yes ivil Code Sections 11014:_through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,t•:, 1-4,No Go lo-Qon
_ -
2. Does your real property have a licensed p umber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserviril:plumbing fixtures is not technically feasible?
0 Yes Civil Code Sections 1101.1 ough 1101.8 do not apply.
0 The licensed plumber's celification has been provided to the Building Division.
Skip the rest of the form and siti bottom of form.
*79 CI:No Go to Question 3.
,,,...,
3. Is water service permanently disconnects m for your building?
/ 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
..i!i ,[1..1 No Go to Question 4.
4. Is your real property built arid available fel use or occupancy on or before January 1, 1994?
0 No My real property is built and a ailable for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 thrbugh 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
L3 17..,Yes My real property is built and mailable 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:
,e-----,
,i 1 11111- 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 imprevernents).
Li 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 throughok the building(regardless of whether property undergoes alterations or
improvements).
0 My property is a commercial real propel ity. 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 later-conserving plumbing fixtures.
specified building
or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the buildihg(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 Phu bing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the wate-conserviriA plumbing fixtures comply with the requirements as indicated the
table on the following page. ) ) Date.:,), ,i- 1: /7)v
4, 1
—
Owner or Owner Agent's Signature{ J *----/-,,,t a / _, . . j 7-24*/
Upon completing and signing thiSSC-ertif"ci'-ail-,pl eA‘e return it toy Building Division in order to final;your bui4ling-iPermit.
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SB4072015.doc revised 08/26/15
_ -,...k SMO E / CARBON (6--3 0
MONOXIDE ALARMS
/..0 OWN R CERTIFICATE OF COMPLIANCE
�yr.rys. COMMU ITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION t s'
CUPERTU40 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 J t`r
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(408)77 -3228•FAX(408)777-3333•buildinq( cupertino.orq
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Pmt RMITICANNO $BEJINALED LINT-:' THIS CCRT.IPICATE HAS BEEN
s O A 1 +Ji iiwii1 ®� i SND ®e 11.' --
i -. -- ®� -t.TO TI I T DING I S O ,_ .
PURPOSE =
This,affidavit is a self-certification or the installation of all required Smoke and Carbon Monoxide Alarms for
I
compliance with 2013 CRC Section I, 314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for ,
inspections are required.
GENERAL INFORMATION
Existingsingle-family and multi-f. m
g y �' 1y dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valua Ilion of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CB Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in till.,following locations:
1
•0 EA • SMOKE ALARM CO ALARM
Outside of each separate sleepinm`area in the immediate vicinity of X I X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
d
1
Carbon Monoxide alarms are not regi uired in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Ci-bon 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. I
I
Power Supply:In dwelling units wiul no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms arr permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall an. ceiling finishes or there is no access by means of attic,basemen or crawl
space.Refer to CRC Section R314 an: CBC;Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to 1e building wiring.
As owner of e above-referenced p operty,I hereby certify,that the alann(s)referenced above has/have{ave been
installed; accor ance" wail Ile m ° i ac 's instructions and in compliance with the California.Building
and Cal''ornia Residential Codes. TI e alarms specified below have been tested and are operational, as of the
date sig ,ed below. A _ _
6-7
Address: -,
7 i " t...V W /' / !2e �` 't' 44') `�Jo/
�Jlt � Permit Na. 1
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Specify Nu ser of Alarms: #Smoke Alarms: 1-3-1---1 #Carbon Monoxide Detectors:
readnd agree to comply with,tlap terms and conditions of this statement
Owner(or Owner Agent's)Name: /> _ /
Signature p Da e: 67 f,? C//
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Contractor Name: I
ignature Lic.# Date:
I
Smoke and CO form.doc revised 09/27/16
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