B-2017-0774CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0774
10472 JOHNSON AVE CUPERTINO, CA 95014-3814 (375 26 043)
SANTA CRUZ
WESTSIDE ELECTRIC
INC
SANTA CRUZ, CA
95060
OWNER'S NAME: TAN PETER L K AND HING JENNY H
DATE ISSUED: 05/17/2017
OWNER'S PHONE: 408-464-3308
PHONE NO: (831) 469-8888
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC -10 Lic. #846294
Contractor SANTA CRUZ WESTSIDE ELECTRIC INC Date 04/30/2019
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) 21 -PANEL ROOF MOUNTED PV SYSTEM (5.36 KW)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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 I have and will maintain Worker's Compensation Insurance, as provided for by
1 Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $18743.00
permit is issued.
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
375 26 043
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 understands and will comply with all non -point
source regulations per the Cupe no Mu icipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/17/2017
Issued by: PAUL O'SULLIVAN
OWNER -BUILDER DECLARATION
Date: 05/17/2017
I hereby affirm that I aro exempt from the Contractor's License Law for one of the
RF-ROOFSe
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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: 05/17/2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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. 1 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 ode, hapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25 05, 25 3, a 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
c
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05/17/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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 05/17/2017
CUPERTlINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@cupertino,oro
PROJECT ADDRESS 10472 Johnson Ave, Cupertino, CA 95014, US
APNN 37526043
OWNER NAME Peter L K Tan
PHONE (408) 464-3308
E-MAIL petertansil@hotmail.com
STREET ADDRESS Same as above
CITY, STATE, ZIP
FAX
CONTACT NAME Kristi Cassetta
PHONE 831-226-9363
E-bIAIL kcassetta@sandbarsc.com
STREET ADDRESSCITY,
2119 Delaware Avenue
STATE, ZIP
Santa Cruz Ca 95060
FAX
831-515-5098
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IM CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Sandbar
LICENSE NUMBER
846294
LICENSE TYPE
C-10
BUS. LIC #
�anfa''er z Westside Electric dba Sandbar
E-MA
Kristi - kcassetta sandbarsc.com
FAX 831-515-5098
STREET ADDRESS
2119 Delaware Avenue
CITY, STATE, ZIP
Santa Cruz Ca 95060
PHONE
831-469-8888
ARCHITECT/ENGINEER NAME Sungevity
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
Jeramiah - jdean@sungevity.com
FAX
STREET ADDRESS
Franklin Street Ste. 310
CITY, STATE, ZIP
Oakland CA 94607
PHONE
y66
USE OF yql SFD Or Duplex ❑ Multi -Family
STRUCTURE ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
IX SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FORSOLARPANELS, NUMBER OFPANELS/UNITS: 2-1 KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION. $18,743
P
DESCRIPTION OF WORK Installation of a 5.355kw grid tied photovoltaic solar array roof mount
RECEIVED BY WA_
By my signature below, I certify to each e 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 h e vid d is orre L I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to b ildin ons i I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 5/ 17/'17
MENTTj(A,L INFORMATION REQUIRED
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USE ONLY
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❑ EXPRESS
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❑ STANDARD
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PVApp_2011.doc revised 03/16111
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COIViMUNITY DEVELOPIViENT DEPARTMENT • BUILDING DIVISION
CUPERTI NO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building @cupertino oro
PEg21lHT CANNOT BE FINAL ED UNTIL T: - CERTIFICATE SAS BEEi�
COATPLETED, SI _NFD A1�D I2ETL1I2tlT� TO THE BUILDING DIVISION
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, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single -fancily 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, R315, and CBC Sections 907.2.115 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) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
( X
X
Within each sleeping room
X
Carbon Monoxide alai -ins are not required in dwellings which do not contain fuel -burning appliances and that
do not have anattached 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 um
nits with no commercial w
l poer supply, alarm(s) may be solely battery operated.
In existing dwelling urdts, 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 v,7hich must be connected to the build rig 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.
Address: _1472 Johnson Avenue Cupertino 95014 Pertnit No. B-2017-0774
Specify Number of Alarms: � 9 Smoke Alarms:F_7_
Y Carbon Monoxide Detectors: r
I have read and agree to comply v<,Ah (jie terms a conditions of this statement
Owner (or Owner Agent's) Name:
Signature..,—
Contractor name: t , _ 1.` .
................................................
`
Signature...................................................................... Lica........................................ Date:...................
Smoke and COjorm.doc revised 0111012017
i
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOKIiENT DEPARTIAENT ^ BUILDING DIVISION
CUIPERTINO 103DO TORRE AVENUE • CUPERTINO, CA 95014-3255
408) 777-3228 • FAX (408) 777-3333 ^ buildinofa�cuoertino.oro
&caner frame Peter L. K. Tan Permit Ilio. B-2017-0774
Address 10472 Johnson Avenue Cupertino 95014
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1. 1 through 1.101.8 do not apply. Sldp the rest of the form and sign bottom, of form.
EYNo Go to Question 2.
2. Does your real property have a licensed plumber certif ,ring that, due to the age or configuration of the property or its
plumbing, installation of water-conservincx plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply.
❑ The licensedpiumber's certification has been provided to the Buildi-ng Division.
�,r% Ship the rest of the fonn and sign bottom of form.
� No Go to Question 3.
Is e=ater service per aianently disconnected for your building?
❑/Y
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip he rest of the fcnn aad sign bottoim of form.
!�" ITo Go to Question 4,
4. Is your real property built and available for use or occupancy on or before January i, 1994?
{
No Aly real property is built and available for use or occupancy ager January 1, 1994.
Civil Code Sections 1101.1 thr•ouch 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
❑ Yes 1�4y 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.,
Please check ONTE of the following:
bfy proper ty is a si77gle 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 plurnbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or irnprovements).
L Dry property is a nr.7lt;fana.ily residential neer proper ty. See Civil Code Section 1101.5.
Or. and after January 1, 2014, specified building alterations or irnprovenients shall require non- compliant
plumbing fixtures to be replaced with water -conceiving 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).
❑ Mypropeity 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 fig: i u•es to be., lviihcaater-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fi; u-cs shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
1, as the owner or oN�mer's agent of this property, certify under penalty of penury that non-compliant plumbing fixtures es wil1 be
replaced prior to date speci£ed above with ±;rater-consei-nirgpluimbing fixtures in accordance ;with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and nnanufacturer's
installation requirements, and that the twater-coaservun�plwrbing fi? . yes comply «=illi the requirements as indicated in the
table on the followins ease. ' i
Owner or Owner Agent's Signature: . P,� - Date: 1 ,
� :TR .. T TT
Upon completing and signing this eitifcate; please rerun it to the Bui}ding Division in order to final your building penr_it.
SB407 2013.doc revised 01/05/17