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15040139M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10228 PASADENA AVE CONTRACTOR: VIVINT SOLAR PERMIT NO: 15040139 DEVELOPER LLC OWNER'S NAME: GOVINDARAJU MADHUKAR AND CHAYA M 3301 N THANKSGIVING WAY STE 500 DATE ISSUED: 04/20/2015 OWNER'S PHONE: 4086911896 LEHI, UT 84043 PHONE NO: (801) 234-6399 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALL 14 ROOF TOP, FLUSH MOUNTED PV MODULES �/yy License Class�� Lia q 7i t� (3.5KVV) LLC Contractor Date . 1 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. I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $17500 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 APN Number: 35718041.10228 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgment costs, and expenses which may accrue against said City in consequence e granting of this permit. Add it' Hall ,the applicant understands and will comply y: Date: with all non -point source re atio s per the Cupertino Municipal Code, Sect' 9.18. (./ 17n) RE -ROOFS: Signature Date ! All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that l am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec. 7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. [will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay rea it On lily Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cu rtin 1unicipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sections33, and 25534. permit is issued. Owner or authorized agent: Date: 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATioN COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION vl 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 I CUPEf�T'INO (408) 777-3228 • FAX (408) 777-3333 • build ing(d)cupertino.oro \� PROJECT ADDRESS `O /1 ^ p� � L'Gb 1 I AP"" I OWNER NAME V� PHONE®� r (e /_ E-MAIL t1 STREETADDRESS 10, ^ CRY, STATE, �P \,no-lrD IL FAX `4.08-451•-9472 ''. CONTACT NAME Hannah Nguyen PHONE E-MAIL sanjosesolar@vivintsolar.com ''.. STREET ADDRESS 1939 Hartog Dr CITY,STATE, 'LIP San Jose, CA 95131 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ® CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Vlvtnt Solar Developer, LLC LICENSE NUMBER 973756 LICENSE TYPIC46, Cil C BUS, LIC H 34972 COMPANY NAME Vivint Solar Developer, LLC E-MAIL sanjosesolar@vivintsolar.com FAX STREETADDRESS 1939 Hartog Dr CITY,STATE,ZIP San Jose, CA95131 PHONE 408-451-9472 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC k COMPANY NAME E-MAIL FAX ''. STREETADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCfURE: ❑ Commercial PROIECr IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No ® SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOUR PANELS: NUMBER OF PANELSIUNITS: N KILOWATTS: 2 4 TOTA JAL` AT ION. 1 ''. DESCRIPTION OF WORK Residential Solar Photovoltaic Rooftop Installation, 3 ®5 kW ( `l. panels) By my signature below, I certify to each of the foil ing I am the property owner or authorized agent to act on the pr rty owner's ave read this application and the information l have provided is orre I have read the Description of Work and verify it is accurate. I agree y with all applicable local ordinances and state laws releting to building co ruct' n I authorize representatives of Cupertino to enter the above-identiif property for inspection purposes. Signature of Applicant/Agent: Date: L' I (!,G/15 SUPPLEM ItTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-TIIE-COUNTER ❑ EXPRESS ❑ STANDARD g m ❑ LARCE -MAJOR} PVApp_2012.doc revised 06/20/12 cCffTY OF CUPERTINO mm PEE ESTIMATOR — BUILDING DIVISION NOTA': This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are hated on the nreliminam information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff 7/1/13) 90228 PASADENA AVE DATE: 04/20/2015 REVIEWED BY: MELISSA Pbunh. flan Check A1PN: BIP#: 'VALIDATION: 1$17,500 .iAADDRESS: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Other Elec. Imp. PENTAMATION SOLAR -RE PERMIT TYPE: A P/unrb. Fnsp. Fee: INSTALL 14 ROOF TOP FLUSH MOUNTED PV MODULES 3.5k SWORKPE SCOPE NOTA': This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are hated on the nreliminam information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff 7/1/13) FEE QTY/FEE Mech. Plan Check Pbunh. flan Check Elcc, Plan Check ltech. fermi! Fce: Plumb. Permit Fee: l lec. Permit Fee: Other Alech. Insp,E] Other Plumb Insp. Other Elec. Imp. Ifech. insp. P'ee: P/unrb. Fnsp. Fee: Elec. Insp. Fee: NOTA': This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are hated on the nreliminam information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $236.00 Alternative Energy System IPHOTOVRES Photovoltaic System Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hr $0.00 _s PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 111x: Administrative Fee: Q Work Without Permit? ® Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Trawl Doc°uinentalion Fees: Strong; Motion Fee: IBSEISM/CR $2.28 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.28 $236.00 TOTAL FEE: 1 $239.28 Revised: 04/01/2015 CUPERTINQ WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building .cupertino.org Owner Name G�011111 d'Im')y lVaolhulrard Abtzmp Permit No. I 0yol.�,)I Address l 2Z� PaCPa At'e2 CUI9W_f1402 C4 Please refer to the attached California Civil Code Sections 1101.1- 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: k'-1-5( 1:2-p 1 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 plurnbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Buildinig Division. Sign below and skip the rest of the form. Owner' Signature:111_1 }� Date: 1� No Go to Question 3. _ - , 3. Is water service permanently disconnected for your building? �O ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: _ Date: No 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 January 1, 1994. Civil Code Sections 1101.1 through 1101.8 Ido not apply. Sign below and skip the rest of the form. Owner' Signature: " " r Date:�� orYes My property real is built and�availefor use or occu cy on or before January 1, 1994. Civil Code Sections 1101.1 through 110 1. 8 apply. Refer to the attached. OMy 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 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). ❑ My property 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 plumbing fixtures to be replaced with water -conserving plumbing fixtures. EB40720I5.doe revised 02/04/15 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/We, the owner(s) 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 Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures com ly with the requirements as indicated in the table elow, Owner's (or Owner Agent's) Signature: Date: 2 5- 2" iv Upon completing and signing this Certificate, please return it to the ilding Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Fixture/ (Fixture Complying with Current Code Applicable to New Construction) —Plumbing Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch, 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4,3 2013 CALGreen Div. 5.3 Single -f=amily Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all Showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04/15 CU'PERTINO Address SMOKE ! CARBON MONOXIDE ALARMS 1� OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - build'sng(@Gui)ertino.org l0 22 2 P41,0 denq ,4Ve 'Venflno, C4- , .fa Y0/3 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 R31.4 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 the bedroom(s) X X 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 CSC 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 alarm(s) referenced above has/have been installed in accordance with the manufacturers instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and a ree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: J A d1n�T y �} Signature.................................................................................................................. Date: `(.... .4 .1 Contractor Nam . C.UU E. 0 I�...... �{Q ....... .. Lic.# ......................... .... Date: ................ . Smoke and CO form. doe revised 03/18114