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B-2016-3175 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3175 10545 DEODARA DR CUPERTINO,CA 95014-2430(316 30 044) ENERGY REMODELING INC WOODLAND HILLS, CA 91367 OWNER'S NAME: HOPKINS CHARLES V AND ETHEL B DATE ISSUED:11/28/2016 OWNER'S PHONE:408-252-8690 PHONE NO:(877)245-4672 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lie.#968844 Contractor ENERGY REMODELING INC Date 12/31/2017 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL 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. - JOB DESCRIPTION: (N)11 PANEL ROOF MOUNTED PV SYSTEM(2.86kW) 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 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 u1 ,1 '.1 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000.00 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 30 044 • 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 understan.s and will comply with all non-point source regulations per/ a Cup.rti..Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 11/28/2016 Issued by: v LI : -;5.. Date:11/28/2016 .N 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. 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:J1/28/2016 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. 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 s. 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 25505,25 33,'a d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked, Owner or authorized agent: //LivvL. APPLICANT CERTIFICATION Date:11/28/2016 '' . 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 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, 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 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 11/28/2016 Professional \ ALTERNATIVE ENERGY PERMIT APPLICATION :: , , COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONAE �C,9 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255. CUPERTINt7 (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino:orq ?3- 20/6 3 � S PROJECT ADDRESS jO9- St(U\ * ,3 L4 r 3 ` 7- OCf OWNER NAME,'�-"' \ O -(n k.1 PHON V 2Z-O 11 7 E MAIL STREET ADDRESS( G� y� f CITY,STATE,ZI 7 ' 1054 5 Geo AcA rc (Ar. ��J pe e 1�(1��t/lr/0/50AIL / FAX CONTACT NAME spry •n^ e f / { 1,/ri `� l Y � � \ PH UFc-____G),(9. c� �� E-MAIL STREET ADDRE s2 U i rl VS A� 1 CITY JT�AT�E,u l-c j (CCS 921 Z3 FAX ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR° EN'""" e.r f{.co LICENS5Mq LICENS CPE .y I._BUS.LIC COMPANY NAME' / f g h y2r ee�c h Agev�- I @n�r,5airvIv�� l `'l FAx J LI sT3 RESPU 2�et CI Tr1ELt vo l l G zC� fe _737_ (- c(�( ARCHITECT/ENGINEER NAME LICENSE.NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OFSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: 0 Commercial URBAN INTERFACE AREA ❑ Yes I� No FLOOD ZONE 0 Yes No SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ❑ 'f' OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/[JNITS: KILOWATTS(COMMERCIAL ONLY..eco TOTAL UtAI TIMI n DESCRIPTION OF WORK V 1 LA Aocto ,s „,,,,,...e__: ) -Inv cd-, r• Are,-61 -z_e_ 12-EG 160 P C-• a r-f - " ;e a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act Onnie property owner's pe a1£ I have read this application and the information I have provided isl correct. haw-read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bte3 co5� ction. a orize representatives of Cupertino to enter the above entifi d pro pperty for inspection purposes. Signature of Applicant/Agent: -41, Date: 11 � � k9 SUPPLEMENTAL INFORMATION REQUIRED - - z24.,,..,4„,,, �� . a OFFICE USE ONLY s c�„K„`' �1 JJl / / // / __ /9// /�� OVER THE COUIeTER , EXPRESS ,�� J� //fJ� 1 C�'� h W 1] STAIv'DARD -” 4-- Ai; 0 LARGE <..':. a; . F„ PVApp_20I1.doc revised 03/16/1.1 1 • \NI /. WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE 0 \ COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION • - CU P ERTI N 10300 TORRE AVENUE.CUPER11NO,CA 95014-3255 (408)777-3 : (498)7 7-3333.building us ertino.o Owner Nami, , _ - , , PermitNo .< Addrelt ,„ 2). 1. Is your real property a registered historical site? Cly-es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1-47:1„ 74 No Go to Question 2. 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? 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. , No Go to Question 3. r#36 3. Is water service permanently disconnected for your building? O Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. .121"No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? O 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. 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 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please cheek ONE of the following: 144_21d My property is a single-faintly 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 1,2047,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). O Myproperty is a mukfamily 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 WO-re January 1,2019),all non-compliant plumbing fixtures shall be repladed with water- conaerVing plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). O My property is a commercial real property. See Civil Code Section 110)1.5. On and after January I,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). I,as the owner or owner's agent of thisproperty,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 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 61T Owner Agents SfgnatUre,:,; Data:.I Ii Upon completing and signing this Certificate,please return it to the•Building Division in order to'final your building permit. SB-4072015.cibe revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS kOWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinqa.cupertino.orq PERMIT CANNOTDB.E F NAL E; `1Th FTL TBTS'GER 01.0-AnAAg.isEtri, plAia 5160 �• E D`S Fs9, ti 1 U1 ND IMIIMM1WD 1 9 S O 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. In 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 alarms)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. �cIdress ��(.,&�'"! i. / Permit-NO. "261 7r2-r FS-pecify Number of Alarms: # Smoke AlarmsWM. (#Carbon Monoxide Detector- I have read and agree to co ply with the terms and conditions of this statement Owne (or Owner Agent's)Name: W*l 7 Signature ..Date: V Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 09/27/16