B-2017-0796CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0796
19045 PENDERGAST AVE CUPERTINO, CA 95014-3516 (375 37 045) CLEAN SOLAR INC
SAN JOSE, CA 95112
OWNER'S NAME: JU WEI-DE AND SU -LING
OWNER'S PHONE: 408-480-1211
LICENSED D ONT A TOR'S DECLARATION
License Class C-10: C46 Lic. #$14$45
Contractor CLEAN SOLAR INC Date 02/28/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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.
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, judgm , and expenses which
Eayccrue again s d City in conse nce o�the ranting of this permit.
onally, the pli nt understan a d will ly with all non -point
e reaulatio s n the.CuDerti o mciDale. Section 9.18.
Date 5/18/2017
that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, 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)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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.
i. 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 5/18/2017
DATE ISSUED: 05/18/2017
PHONE NO: (408) 217-8876
BUILDING PERMIT INFO:
X BLDG X ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) 16 -PANEL ROOF MOUNTED PV SYSTEM (4.48 KW); (N) LOAD
CENTER (60 AMPS)
Sq. Ft Floor Area: I Valuation: $13250.00
APN Number: Occupancy Type:
375 37 045
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 05/18/2017
RE -ROOFS:
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.
Signature of Applicant:
Date:/518/2017
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 a
con minants as defined by the Bay Area Air Quality Management District I
Will t n compliance with the Cupertino Municipal Code, Chapter 9.12 and
e Health & Safety Code, Sections 25505, 25533, and 25534.
Ow o authorized agent:
Dat .
CONSTRUCTION LENDING AGENCY
I here 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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM '
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LICENSE NUMBER
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USE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ` ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes .j; -NO
PROJECT IN
FLOOD ZONE ❑ Yes E�'No
SOLAR PANELS
TE ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
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TOTAL VALUATION lyn 1 ' )1 �] •�
DESCRIPTION OF WORK
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RECEIVED BY:
By my signature below, I certify to each of the f low' g:
application and the information I have provide s ect.
ordinances and state laws relating toI3rng s ctio
e
Signature of Applicant/Agent:
I am th 'property 6w or authorize agent to act on the property owner's behalf. I hav read this
I have property the cription of Wo and verify it is accurate. I agree to comply with all applicable local
I authon re es tives of pertino to enter the above-ident' led ro erty for inspection purposes.
Date:
SUP ENTAL INFORMAT ON Q D
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
❑ EXPRESS
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PVApp_2011.doc revised 03116/11
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CUPERTINO
Address IW*5 7t
PURPOSE
SMOKE 1 CARBON MONOXIDE ALARMS TJ
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 55014-3255
(408) 777-3228 - FAX (408) 777-3333 - building9kupQrtino.org
., '` hfll'lglti i1l'll.
PERMIT CANNOT BE 1~INALED AND CO;VPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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 INFOR'NATION
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 8314 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
Chttside of each separate sleeping area in the immediate vicinity of the
bedroom(s) _
X
X
I On every level of a dwelling unit including basements
X � j X
1Within 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 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 CItC 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 alarm(s) referenced above has/fiave been
installed in accordance with the manufacturer's 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.
1 have read and scree to cw wlv with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
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Contractor Name:
Si tire. .Lie.# » Dale:
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SIGNATURE
CLEAN
SOLAR INC.
1445 KOLL CIRCLE,
SUITE 109
San Jose, CA 95112
Cont. Lic# 910549
www.ceansoar.com
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