B-2017-0031CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:,
CONTRACTOR:
PERMIT NO: B-2017-0031
6137 BOLLINGER RD CUPERTINO, CA 95014-4629 (375 38 011)
SENDER SOLARIS
CONSTRUCTION INC
EL CAJON, CA 92020
OWNER'S NAME: BHATT RONAK AND ANIALI
DATE ISSUED: 01/18/2017
OWNER'S PHONE: 408-504-4847
PHONE NO: (619) 715-4054
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lic. #978152
Contractor SEMPER SO ARIS 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:
(N) 21 - PANEL ROOF MOUNTED PV SYSTEM (7.25 kw); (I) 125
I hereby affirm under penalty of perjury one of the following two declarations:
AMP LOAD CENTER
m. 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
REV#1 - ADD -(l) NEW PANEL TO EXISTING SCOPE OF WORK -
performance of the work for which this permit is issued.
(7.59 KW) ISSUED 3.22.17
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: $32600.00
APPLICANT ANT RTIFI ATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
375 38 011
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.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
r%
Signature t -� __..,_ Date -3.22.17
Issued by: SEAN HATCH
OWNER -BUILDER DECLARATION
Date: 01/18/2017
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
m. 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 (Scc.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: 3,2.1.7
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
m. 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 Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, 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: 3,22.17
1 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,
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 3.22.17
Professional
•
ALTERNATIVE ENERGY PERMIT APP `F,0,O�6N
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING I I' #4A
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build in cu pertino.qM
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PROJECTADDRESS "30 & A
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APN # 97:5
OWNERNAME--j7Z'e>/uA 14I, ,
PHONE
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STREET ADDRESS _
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 11 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCMTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
f' ��i�
PHO E
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ARCHITECTBNGINEER 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: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes O
FLOOD ZONE ❑ Yes XNo
OLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): F>
TOTAL VALUATION:
DESCRIPTION OF WORK
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4COPS e5P7 i
RE D BY:
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 to building construction. I authorize representatives of Cupertino toe the above -identified property for inspection purposes.
w•----�
Signature of Applicant/Aent; " DaSUPPLEMENTAL
INFORMATION REQUIRED
OFFICE USE ONLY
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PVApp 2011.doc revised 03116111
0
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0031
6137 BOLLINGER RD CUPERTINO, CA 95014-4629 (375 38 011)
SENDER SOLARIS
CONSTRUCTION INC
EL CAJON, CA 92020
OWNER'S NAME: BHATT RONAK AND ANJALI
DATE ISSUED: 01/18/2017
OWNER'S PHONE: 408-504-4847
PHONE NO: (619) 715-4054
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B. C-10 Lic. #978152
Contractor SEMPER SOLARIS CONSTRUCTION INCDate 90/31/2018
X BLDG X ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL—COMRCIAL
— ME
with Section 7000) of Division 3 of the Business, & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
(I) 21 - PANEL ROOF MOUNTED PV SYSTEM (7.25 kw); (1) 125
I hereby affirm under penalty of perjury one of the following two declarations:
AMP LOAD CENTER
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
erformance of the work for which this permit is issued.
ilave 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: $32600.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
375 38 011
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.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatu18.17
Issued by: SEAN HATCH
OWNER-B MLD_ERDECLARRATION
Date: 01/18/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF- F ROOF
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. 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 (Scc.7044, Business & Professions Code)
z. 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: 1.18.17
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
i. 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 Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, 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: 1.18.17
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,
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.
1 understand my plans shall be used as public records.
Licensed
SiSignature Date 1.18.17
9
Professional
CUPERTINO
ly2or�- O061
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org
PROJECT ADDRESS � ? t �d � ! ,7 �
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APN #
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OWNER NAME I7-6�(�� ���C•�T PHONE
E-MAIL
STREET ADDRESS
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CONTACT NAME
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CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENTCONTRACTOR ElCONTRACTORAGEA'T ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
Iq
CONTRACTOR NAME
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LICENSE NUMBER
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LICENSE TYPE
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BUS. LIC #
COMPANY NAME
E-MAIL
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STREET ADDRESS
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CITY, STATE, ZIP
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PHONE
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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: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ NO
FLOOD ZONE ❑ Yes ❑ NO
IV SOLAR PANELS ,
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): '
TOTAL VALUATION•
DESCRIPTION OF WORK �
SNS Ac.c ( Sp t,A 5�-- PA,tf,5�Gs A -PP <c/
RECEIVED BY: �
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 b half. I bavefead 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 to ilding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purpose s,_,-%
Signature ofApplicant/Agent• Dater
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
a
UN'TER-
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AIAJOR
PVApp_2011.doc revised 03/16/11
T.
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTIINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 77773228 • FAX (408) 777-3333 • building(a)cupertino.org
PERMIT CANNOT -BE FINALEA UNTIL THIS CERTIFICATE HAS BEEN
f"'4t3'R Amir`v. 'i';`.rR GY`t'iYt►ca:titi a ? . r. sir.�r, :Ts. ;aP. :.,,-,a t,:. �,.�.5 :��_.,,..+... _... _... �..._. ... a.._ ..
PURPOSE _
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314, 2016 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
alarms. When the valuation of additions, alterations, or repairs 'f_ x— sting`dweltuig�units exceeds -
Monoxide .____._
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms andjor-Carbo__
Monoxide Alarms be installed in the following locations: - - - -
AREA
- 1bIflK1wA RM o.
W:, -GO ALAR --M ...... _:....k_ _ _..
Outside of each separate sleeping area in the immediate vicinity of_.- -
bedroom(s)
X _ __the
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:.i ot_� ntain _fiiel-burnii _a. I%ahces._a ld :#I of=_,
v S iP.
do not have an attached garage. Carbon monoxide alarms combined vvith_smoke alarzs shallcompiy yvxth_ _.
CBC Section 420.6 and shall be approved by the Office of the State -Fire lVIarsltal:.
Power Supply: In dwelling units with no commercial power supply, alarm(s) maybe solely.hattery _operated;_--
In existing dwelling units, alarms are permitted to be solely battery' rated where repairs ox:aiteratiQns do- .
not result in the removal of wall and ceiling finishes or there is no access by means of attic, -basement. or:crawl,.y�
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An -electrical -permit. s.:required for -
alarms which must be connected to the building wiring. -
As owner of the above -referenced property, I hereby certify that the alarm(s) 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. `b_?_019---0Q3j
Address: 6T f, Permit No. '
Specify Number of Alarms: #Smoke Alarms: r1 # Carbon Monoxide Detectors:
I have read .and agree to comply v�j the terms and conditions of this statement
Owner Agent's) Name:
, r
-Owner
{"`� ° t
Signature ..................... ... ..................................................................................Date:
.................................................................................................................................
Contractor Name:
Signature.................................................................. Lic.#...................................... Date:
Smoke and CO form.doc remised 12115/16