B-2017-0859CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0859
22356 RANCHO VENTURA ST CUPERTINO, CA 95014-2736 (357 03 055)
CLEAN SOLAR INC
SAN JOSE, CA 95112
OWNER'S NAME: EDELSON DANIEL R TRUSTEE
DATE ISSUED: 05/31/2017
OWNER'S PHONE: 408-462-0746
PHONE NO: (408) 217-8876
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lic. #910849
Contractor CLEAN SOLAR INC Date 02/28/2018
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) 20- PANEL ROOF MOUNTED PV SYSTEM (6.4 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
erformance 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
Sq. Ft Floor Area:
Valuation: $26000.00
permit is issued.
APPLICANT CERTIFICATION
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
35703 055
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 Ila bilitie , ludgmen costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence f the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the a cant understands and I comply with all non -point
source regulatio p r the Cupertino Mu ' ipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-31-2017
Issued by: Kim Dunbar
Date: 05/31 /2017
U DER DE A ION
7hre4byr. hatI 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
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 (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: 05-31-2017
I 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 whi t hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Ara Air Quality Managemen istrict I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cope ti o Municipal C e, hapt�r .12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, S ti s 25505, 255 , d 25534
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05-31-2017
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
I hereby affirm that there is truction 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 05-31-2017
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(cDcuperlino.org
zo i -�-^ 5—
PROJECT ADDRESS / ? �3 APN # _— q 3
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OWNER NAME
PHONE
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E-MAIL
STREET Agg.,--? /Jn � � CITY, STAT P S n u FAX
CONTACT NAME
PHONE � E-MAIL
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STREET ADDRESS/, `, p
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CITY, STAT IP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM /_' / �_\
LICENSE NUMBE U /,j
LICENr
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BUS. LI,
COMPANY NAME E-MAILCl
FAX
STREET ADDRESS / /4/ CITY, STATE', IP - II
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PHONE �� ' j
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY ME
E-MAIL
FAX
ET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
STRUCT RE: Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes NO
PROJECT IN
FLOOD ZONE ❑Yes -L -Ncr
VOLAR PANELS
TO ELECTRIC VEHICLE CHARGING STATION
El SOLAR WATER HEATING
El OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: r o KILOWATTS (COMMERCIAL ONLY):
v
TOTAL VALUATION#q
�V
DESCRIPTION OF WORK L /�
7
By my signature below, I certify to each of e f owing: am the prop o er or uthorized agent to act on a property owner s behalf. I have read this
application and the information I r I s correc . I have read escripti of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel g to b ng co struction. a representa ' es of Cupertino to enter the above -id Ied pro erty f r inspection purposes.
Signature of Applicant/Agent: Date:
EMENTAL INFORMA REQUIRED
�V O�
OFFICE USE ONLY
v
Or
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
MAJOR
PVApp_2011.doc revised 03/16/11
I SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO
(408) 777-3228 •FAX (408) 777-3333 • buildin_
cu Ertino org
PER11'RT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SLU, AND RETURNED 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-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, R315, 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) - (Smoke alarms shall not be Iocated 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 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 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:t_ �(�j<
Permit No.
Specify Number of Alarms: # Smoke Alarms: r 77-1 # Carbon Monoxide Detectors: 1 �-
I have read and agree to comply with the terms and conditions of this statement
Owner (or owner Agent's) Name: t// 1j
Dolle/ ECG'-LSL�'1 Sianature......!�lrF ..G :.....�.�� i�"� ...............Date6/Z;)Zo
.......................................................... Lic.#......... - ..... .....................
Smoke and COjorm.doc revised 01/1(0'2017
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • ELILDING DIVISION
CUPERTINd 10300TORRE AVENUE • CUPERTiNO, CA 950",4-3255
(408)777-, 22� FAX (408) 777-3333 • building0cuoertino.orq
Owner Name `� 4) 3t 17 .'_�..k'_i � �� Permit Nc�� ?`--� Ii ' i\ ._"
_4C
1. Is your real property a registered historical site?
❑ Yes Civil Code, Sections_ 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 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 eater -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 Building Di:-ision.
Skip the rest of the foram and sign bottom of form.
4 � 'N'o Go to Question 3.
Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form.
�2' 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 do not apply. Skip the rest of the form and sign bottom of fore.
O''Yes My real property is built and available for use or occupancy on or before January 1, 1994,
Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form.,
Please check ONE of the following:
My property is a single-family reside tial 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.
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 impro<<ements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replacedpricr 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 rnanufacturer's
installation requirements, and that the water -corse dn2 plumbing fixtures comply Nvith the requirements as indicated in the
table on the followine Daae. _ _
Owner or Owner Agent's Signature:
Date: /ZLJZv? ?
�.b.--. b 1e nwiumg irvision in oraer to anal your building permit.
SB407 2015.doc revised 0105/17