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B-2017-0962 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0962 22025 CREEKSIDE CT CUPERTINO,CA 95014-1103(326 39 039) SLINGSHOT POWER • INC LOS ALTOS,CA 94022 OWNER'S NAME: BHORKARABHAYAND MODAK MANSI DATE ISSUED: 10/05/2017 OWNER'S PHONE:408-242-2169 PHONE NO:(650)308-9055 • LICENSED CONTRACTOR'S DECLARATION BUILDING PERMITINFO: • License Class SOLAR Lic.#984488 Contractor SLINGSHOT POWER INC Date 06/30/2019 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: (N) 16-PANEL ROOF MOUNTED PV SYSTEM(4 KW) I hereby affirm under penalty of perjury one of the following two declarations: REV#1-ADD 2ND INVERTER-ISSUED 6/28/2017 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#2-CHANGE MAN PANEL TO 175 AMPS-ISSUED 10/5/2017 • Compensation,as provided for by Section 3700 of the Labor Code,for the .erformance of the work for which this permit is issued. `:, have and will maintain Worker's Compensation Insurance,as provided for by • ection 3700 of the Labor Code,for the performance of the work for which this P‘Ipermit is issued. Sq.Ft Floor Area: Valuation:$11050.00 APPLICANT CERTIFICATION I certify that I have yead 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 326 39 039 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 u derstands and will comply with all non-point source regulations per the upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 169 • ignature Date 10/5/2017 Issued by:Abby Ayende Date: 10/05/2017 OWNER-BUILDER DECLARATION 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 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 inspeption. 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 8c Professions Code). Date:10/5/2017 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 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 M icipal Code,Chapter 9.12 and • exemption,I become subject to the Worker's Compensation provisions of the the'Health&Safety Code S tions 25 05,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. er or authorized agent: APPLICANT CERTIFICATION Date:10/5/2017 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. I understand my plans shall be used as public records. • Signature Date 10/5/2017 Licensed Professional cPeo ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION , AE >y�Is x 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 UP RTlNp (408)777-3228• FAX(408)777-3333•buildincAcupertino,orq • CPROJECT ADDRESS 2.2b 2 5 G SCK.5 f11 6 CC u �' APN# eJ a7 4::31 _0"7 1 OWNER NAME • p�^,0•�Ary PHONt`togN 2.-.ZIb,6 E-MAIL STREET ADDRESS i V {�r CITY,ST•1`TE,ZIP -f FAX .� t . 0' e .. 'f CONTACT NAME Sf.-1N St4O't' PawEfL (goo) Sal - 4414 E-MAIL STREET ADD ESS CITY STATE,ZIP FAX 11,i t 014 �SIR•E�'� LOS k l f ;,CA 114,0Z 2 ❑OWNER OWNER-BUILDER ',❑ OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TENANT - CONTRACTOR NAME • . LICENSE NUMBER L ENSE TYPE B C SL..lNET'S't„or :Ae.v iz 9,0411$ -t 6 Il s -- COMPVIY NAME MAIL FAX 5u Ne%tot•• 'ow, EA Svm?#P-51•"/thot Fwv4ts Goon ST ET,ADDRESS . CITY,STATE,ZIP - PHONE 4 /�J{lrc J S'nc eer LOS Aire S <eA 4'401 z (Po) $$'t-014114' cL.11� iGIN _$t� LICE4)4.L3471 Bus.LIC# COMPANY NAME_ MAIL FAX SL!t SiFlt?f ow . 4vpf•r+ 51 '41004 pewit. con, IT --- EET ADDRESS CITY,STATE,ZIP �IONE . /Vt4UJ 7 E1 ( DS rito1 CA '1Nat 60 (fl- - USE OF tilt SFD or Duplex'! ❑ Multi-Family ,PROJECT IN WILDLAND PROJECT IN STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes 0 No FLOOD ZONE 0 Yes 0 No MOLAR.PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ❑B�IIOTHER: _ W FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:, • KILOWATTS(COMMERCIAL ONLY): Tl3J$�,L,YAL;AT, ^ fQ r-- DESCRIPTION OF WORK �r ( _ Lu Nei Sesta C how fa -t wkf r t-t,c. - p•/Loa- eco �v 04ickf. A Th y( ) ( 1( D)6 � /111 D PCV ) of S I z -e wir r ci K-e C ms . e vvx 2-06 -- t S Q.v By my signature below,I certify to each of the following: I am the property owner or authorized agent to act oil tie-property own-'s behe t.Thave read this application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local - ordinances and state laws aelati. t.building cons ratio . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. . Signature of Applicant/Agent: /�..r� % •SOW Date: 10 S SUPPLEMENTAL iiNFFORMATION REQUIRLDR2FoFrt :USE O1 1.3 - �,�� ER-Tji1;<C04R2: s . -tit ii_ E.0 STANDARD_ i .,V5' ti PVApp_2011,doc revised 03/16/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0962 22025 CREEKSIDE CT CUPERTINO, CA 95014-1103 (326 39 039) SLINGSHOT POWER INC LOS ALTOS, CA 94022 OWNER'S NAME: BHORKAR ABHAY AND MODAK MANSI DATE ISSUED: 06/19/2017 OWNER'S PHONE: 408-242-2169 PHONE NO: (650) 308-9055 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C -4_E Lic. #984488 Contractor SLINGSHOT POWER INC Date 06/30/2017 X BLDG —ELECT _PLUMB — COMMERCIAL MECH X RESIDENTIAL 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) 16 -PANEL ROOF MOUNTED PV SYSTEM (4 KW) I hereby affirm under penalty of perjury one of the following two declarations: REV #1 - ADD 2ND INVERTER - ISSUED 6/28/2017 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. 2. 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: $11050.00 permit is issued. APPLICANT CERTIFICATION 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 32639 039 326 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 Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature (✓yli�✓/ Date 6/28/2017 Issued by: ABBY AYENDE OWNER DECLARATION Date: 06/19/2017 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: 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: 6/28/2017 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 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 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: 6/28/2017 t" I certify that I have read this application and state that the above information is CONSTRUCTION ENDING 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 6/28/2017 Professional CUPERTINO �wail ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org PROJECT ADDRESS .4PN OWNER NAME ' 4 PHONE Ug �L7 - 11/0671 1 /0Cq t E-MAIL STREET ADDRESS 'Z .L. C r 2 w' S r t c �a V-4- CITY, STATE, ZIP � � v ✓16 C h D FAX CONT CT NAME ( � 0 ow -e P N �C� -q / E-MAIL St'p -f S / She WQ✓.0 STET ADDRESS ITY, STATE, ZIP b Z2 FAX ❑ OWNER ❑ ONT'ER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONRACTORN�tyE k Q� OLL LSC R LI�ENSET E BUS. LIC# COMPANYNJM E- L C FAX T6E4 A REcS3'C_ IIY,STATi> ZIP ONEO© ' G ARCIIITECT/ENGINEER NAME (b^tm <GSD if 922uj LICEI\4 U B R BUS. LIC # MPA NAME n Vyf/��_ W e ► -MAIL .y g FAX { T6E,F A/6D1j�F,$ r �nD - �� { CITY, S'rATE, ZIP 6 Z 001sn USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN VN7LDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ IVO ❑ 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 --r TRECEINIEDBY: "W 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 beh lf. I hate read this application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatinbuilding cons tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: h� Z�II SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER E' i' ❑ EXPRESS U U ❑ STANDARD r �.. ❑ LARGE ❑ MAJOR PVApp_2011.doc revised 03/16111 2/41 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0962 22025 CREEKSIDE CT CUPERTINO, CA 95014-1103 (326 39 039) SLINGSHOT POWER INC LOS ALTOS, CA 94022 OWNER'S NAME: BHORKAR ABHAY AND MODAK MANSI DATE ISSUED: 06/19/2017 OWNER'S PHONE: 408-242-2169 PHONE NO: (650) 308-9055 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-46 Lic. #984488 Contractor SLINGSHOT POWER INC Date 06/30/2017 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) 16 -PANEL ROOF MOUNTED PV SYSTEM (4 KW) 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 e?jam performance of the work for which this permit is issued. +�' z' 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: $11050.00 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 326 32639 039 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 Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature A;" Z1 Date 06-19-2017 Issued by: Kim Dunbar OWNER DECLARATION Date: 06/19/2017 -BUILDER 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 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) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 06-19-2017 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 z. 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, 255,333,,► 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: 06-19-2017 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 06-19-2017 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 - buildino(a)cupertino.org ,9-2-01-4- PROJECT - - PROJECT ADDRESSZ `(� C DE C O u APN OWNERNAME AfMAY O(Lk PHOub ,4 •11 q E-MAIL STREET ADDRESS CITY, STAT—E,, ZIP 7F 0DT* ULF-ralLsIbp C-OuIr 60e64TW6 CA g1up 14 CONTACT NAME N sko"rPOWF.f1. HDNTEo — -0141 E-MAIL STREET ADDRESS CITY STATE, ZIP FAX t c 2 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER E L = TYPE 14 B C /� N w �^ COMr NAME MAIL SI, FAX jow&A S& that #W~ con ST ET ADDRESS 6 CITY, STATE, ZIP CA Root PHONE Sao 699-1-4411y A�JCHITECT,TAGINEER NAME LIC4SE NUMBER BUS. LIC COMPANY NAME g 9AK ooW E-MAIL s�� FAX -- TREET ADDRESS Y C 4 MAW A CITY, STATE, ZIP o Ve ONE a Iff - qqf USE OF -! SFD or Duplex ❑ Multi -Family PROJECT IN'WILDLAND PROTECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No T M/ SOLAR. PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NTUMBER OF PANELS/UNITS: ! KILOWATTS (COMMERCIAL ONLY): T UA YNS—o e --- J v DESCRIPTION OF WORK� OW 1 -!W ,0 w [RECKD B By my signature below, I certify to each of the following: I am the property owner or authorized agent to act orf 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 relatffiglo building cons action. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 45,114117 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OvER-THE-COUNTER F ❑ EXPRESS U l� AIL" ❑ STANDARD p, lO I LN J ❑ LARGE F ❑ `> MAJOR P VApp_201 1. doc revised 03/16111 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE • • • COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION "•ST:lgf�:` 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildinq(a cupertino.orq 3�x;,VI te a i ,�i 0 j�„,c v f y^s p^ -igt�zgi j a` 'fir rs+'4 a,�hr�r�.3f A.s sN rt ' £ �KVS�t3yi^sr'� a t k� � C �`- FIs f �t,�.b .°dkc.�9 , 2 FV At i IPERNI KC�.NNO'I EP�+11\W:P4I N 'IEtPORAfiE HAS BERN "' . � �`4 �K �,P �"'�i`*r� � �'�;w3"�a§nt`,'4�-� w-x S* ".r 'N ,g -_-, �y a��rs�P� .axe. `��y' �,x ��"�'s',�,�j � {„�S� � �"+ v'"��� t<y"' 4 i 3e��' 'f����'S%'�` ���- �T �xm^+z�ra'`" ''S{� fi O 1 E�Eb,SIGNED tANDfRErT RjNEDoTO THE B e NG�I�I TO�� 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- $10000, xceeds$1000;00,ICRC 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 X X bedroom(s)—(Smoke.alarrns shall not be located,within 3 feet of bathroom door) • 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 alaims 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, alainn(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 reinov'al 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. a Address: 2-2-02-c 1pE ;Cr Permit No.2017' d f Z • Specify Number of Alarms: #Smoke Alarms: 5 4 Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's),Name: �{ / A- K � -p-t - Signature ' r/�' Date:V1 'r 7 Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 01/10/2017 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE 40'.,9Ss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUP1 R TINGi 10300 TORRE AVENUE•CUPERTINO,CA 950143255 (408)777-3228•FAX(408)777-3333•buildinoAcupertino.orq 096 z Owner Name AI'3 ir'-I 13 E10 � 2- Permit No. f Address 220-2-c CtP,CEt-S 9113C ' Cr 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. FNo 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 water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Lode Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 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 form and sign bottom of form. kI 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 form. •--Lf Yes My real propertyis built and available for use or occupancy on or before January 1, 1994. Civil.;Code Section s 1101.1 through,1101.8 apply. Check one of the three following statements and sign bottoim of:form.. ' 5. Please check'ONE'of the following: X My 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 replacedwith 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 Ibe,replaced with water-conserving plumbing fixtures. On or before January 1,201,9,all non-compliant plumbing fixtures shall be replaced with water- conserving pluiribing fixtures throughout the building(regardless of whether property undergoes alterations or !i 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 it plumbing fixtures to be replaced with water tconserving 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). I,as the owner,'or owner's agent 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 110L'8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the ' table on the following page. 617' / ii Owner or Owner Agent's Signature: Y Date: 10/7/t Upon completing'aand signing this Certificate,please return it to the Building Division in order to final your building permit. ; SB407 2015.doc revised 01/05/17 it _. _._. _ iv,t BiTiLDI1VG PERMIT CANNOT BE FINALED.AND COMPLETED UNTIL'THLS 3 CERTTl�JCATE`HAS BEEN SIGNED AND�J2ETITRNED TU' lte IDBG DI stici Non-Compliant Water-Conservirig.Plumbing Fixture Plumbing Fixture1 (Fixture Complying with Current Code-Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2016 CPC Ch.4 20.16 CPC Ch. 4 2016 CPC Ch.4 Water Usage 2016 CALGreen Div.4.3 2016 CALGreen.:Div. 4.3 •_2016 CALGreen Div. 5.3 /Flow Rate Single-Family . , 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 riot 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 g:69 psi • th'e above'are'unavailable, Where'faucetsmeeting aerators or other means the above are may be used tb achieve unavailable aerators or • reduction: r `;y�" ' other means maybe' • • di 0. used to°achieve` ,,.r reduction'. ;. T , 1, If the existing plumbing fixture water usage/flow date is'equal to or lower than'the'figure'shown,it is riot required'to be upgraded. C•. SB407 2015.doc revised 01/05/17