B-2016-3042CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3042
20373 VIA SAN MARINO CUPERTINO, CA 95014-6332 (316 01 199) SEMPER SOLARIS
CONSTRUCTION INC
EL CAJON, CA 92020
I OWNER'S NAME: LO LAWRENCE H AND JINNYY TRUSTEE I I DATE ISSUED: 11/04/2016
OWNER'S PHONE: 408-391-4015 I I PHONE NO: (619) 715-4054
License Class b cl0 Lic. #978152
Contractor SEMPER SOLARIS CONSTRUCTION INCDate 10/31/2018
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.
aby 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 X ELECT _PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(I) 14 PANEL ROOF MOUNTED.PV SYSTEM (4.578kW); ADD SUB
PANEL (125 AMP)
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: $20600.00
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
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.
Signature —'` Date 11/04/2016
"N Number: Occupancy Type:
316 01 199
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by:
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
is 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
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
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.
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.
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.
Signature Date 11/04/2016
Signature ofApplicant:
Date: 11/04/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Code, SeoloilL.25505125533, and 25534.
i
Owner or authorized agen
Date: 11/04/2016 -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 building(U-)cupertino.orq
UA
2016
PROJECT ADDRESS ;o l® y �t-zA SA,
) p� �7
A Ca® MiS'L�%J APN # s
OWNERNAME GAc.�i PHaO�NEG�2/.! E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
rcrzrve c4 '95;611-1 �]
CONTACT NAME ,9 lc (l �/ij PHONE �ed
E--MMAILfti&L
STREET ADDRESS CITY, STATE, ZIP FAX
1
�❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT LMJ'CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICEN E ER LICENSE TYPE BUS. LIC #
MP�TZ_ z NI - r3lctc� l
COMPANY NAME c E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
1%3 7 1zR�— /►l��TfF.tJOS AC PT,- . ,S CA q® C.5
ARCHITECT/ENGINEER NAME 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: 0 Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE El Yes ❑ NO
10 -SOLAR PANELS TEI ELECTRIC VEHICLaE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER,OF'PANELS/UNITS: t �%� KILOWATTS (COMMERCIAL ONLY): ®,g �- � TOTAL VALUATION: _ �y
DESCRIPTION OF WORK
L ea f�17 t7 U-zl✓
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 building construction. I authorize representatives of Cupertino to enter theabove-identified operty for inspection purposes.
Signature ofApplicant/Agen �— Date:
SUPPLEMENTAL INFORMATION REQUIRED o Es» ULL
PLOT PLANS CHECKED 13
d I
LAItG
PLANNi NG DEPT
J
PVApp_2011.doc revised 03/16/11
�yK.f9S,y�
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a?
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke oke and Ca
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 w
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarl
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke
Monoxide Alarms be installed in the following locations:
Monoxide Alarms for
no interior access for
and Carbon
elling units exceeds
arms and/or Carbon
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
j
X
On every level of a dwelling unit including basements
X
j
X
Within each sleeping room
X
I
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 rel airs 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 alann(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with tl�le California Building
and California Residential Codes. The alarms specified below have been tested and ark' operational, as of the
date signed below.
Address:
Specify Number of Alarms:
# Smoke Alarms: 1119 1 # Carbon
I have read and agree toxomplAith the terms and conddons of this
Detectors:
Owner (or Owner Agent's) Name:
/
Signature ... t' ............................... ....... .. ...................................................
.
Date:
...........................................................................................................
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
I
i
I
Smoke a' d CO forrn.doe revised 09127116
I
CUPI�RTINO
Owner N
Address 2
COMM UNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingAcupertino.orn
CA S
1 - Is your real property a registered historical site?
❑ es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign
ii bottom of form.
NO Go to Question 2.
2.
I
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?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
Lek" No Go to Question 3.
1. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sib
LJ V No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
6T 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 sif
El Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code. Sections 1101.1 through 1101.9 apply. Check one of the three following sta
bottom of form..
bottom of form.
bottom of form.
and sign
5. VPIse check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4.
1—j
On and after Januai-j 1, 2014, building alterations or improvements shall require all non-complipt plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before Jarrhary 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
0 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 throughout the building (regardless of whether property undergoes alterations or
improvements).
0 Myproperty 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
7 iant
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 ox improvements).
L 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
i
through, 1101.8*, the current California Plumbing Code and. California Green Building, Standards Code, and manufacturer's
installation requirements, and that the water -cog es comply with, the requirei4nts as indicated in the
. serving plumbing fixtu I
table on the following page.
Owner or Owner Agent's
Upon. completing and signing this C I icate, please return it to the Building Division in order to final your. Wilding permit.
Sh407 2015.doc revised 08126115
LAWRENCE LO
4.578 kW (DC)/(AC) PHOTOVOLTAIC SYSTEM
20373 VIA SAN MARINO, CUPERTINO, CA 95014
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