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14060059 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10189 CASS PL CONTRACTOR:POCO SOLAR PERMIT NO: 14060059 OWNER'S NAME: BUFFALOW HENRY JR AND SUSAN 3345 KELLER ST DATE ISSUED:06/10/2014 OWNER'S PHONE: 4087341800 SANTA CLARA,CA 95054 PHONE NO:(408)970-0680 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ ( � Q INSTALL 22 ROOF TOP FLUSH MOUNTED PV PANELS License ClVC �— `i Lic.# `� ��� (5.83 Contracto &q/ Date KW) 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: 1 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. Sq.Ft Floor Area: Valuation:$28900 1 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:35701042.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS 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 DAY ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City,in consequence ofthe granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date G /C ' All roofs shall be inspected prior to any roofing material being installed.If a roof is l installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) 1,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. l 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this O Owner or authorized agent: � Date: permit is issued. 1 certify that in the performance of the work for which this permit is issued,l 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 1 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 t 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 bAE 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 V CUPERTINO (408)777-3228• FAX(408)777-3333•building aacuperlino.org PROJECT ADDRESS �� APN# I OWNER NAME IzV PHONE 115© J 100 E-MAIL VF�AC LO ,^ STREET ADDRESS I0 1 ' �r�ss CITY,STATE,ZIT, I t'0 CA �q FAX CONTACT NAME ,S\ PtIONF{$31 3��' �Z3C E-MAIL. STRL'EI'ADDRESS 33 A.S � l C 1r V C`E, G.✓i`,Z'C,1�:.,A CA CIS CS yv160.3,) 0181 as 3 ❑OWNER ❑ OWNER-BUILDER ❑ OWNE.R.AGENT ❑ C43NTRACTOR FQ CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONT :TOR NAMF,�01( LICENS Oki _ LICENSE TYPE/�_ HUS I,1C N- Cc, mer 1�t c. 3 COMPANY NAMEG E- � ��, � ��� ��� �� /��0� ��� - o e� CMAIL e IN S t" AI, - �( STREET ADDRESS F l'Pr I ry,Sr LATE ZIr A t V C'b OU ARCHITF,CT/ENGINEER NAME LICENSE NUMBER 'BUS LIC k �.� C'S L"o 14v GZC+o r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF K SFD or Duplex ❑ Multi-Family PROJECT IN WIL DLAND PROJECT IN I�r, STRUCTURE- El Commercial URBAN INTERFACE AREA E] Yes NO FLOOD ZONE El Yes ICI NO SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER_ FORSOL4R PANELS: NUMBER OF PANELSIUNITS: 22- #KILOWATTS: �. TOTAL,VALU,ATIOt VU DESCRIPTION OF WORK V p� F�gIJ SL, Od W14 V1n � So aJ CZZ r-\odl� IeS � 1v��le/�er fly my signature below,I certify to each of the following: I am the property owner or au t orized agent to act on the p perty ow have read this application and the information 1 have provided is correct. 1 have read the Description of Wort:and verify,it is accurate. E agw6c comply with all applicable local ordinances and state laws relating to building constructio authori representatives of Cupertino to enter the bo e j entifie�property for inspection purposes. /j `� Signature of ApplicantlAgent: � Date: _ SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Fw� ❑ OVER-THECOIINTER F ❑ EXPRESS x U ❑ STANDARD U .d7 ❑ LARGE a ❑ MAdoR P6 App-2012.doe revised 0620112 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10189 CASS PL DATE: 06/10/2014 REVIEWED BY: MELISSA APN: 357 01 042 BN: b j "VALUATION: 1$28,900 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: PERMIT TYPE: WORK INSTALL 22 ROOF TOP FLUSH MOUNTED PV PANELS 5.83 k SCOPE F-1 Ll _L_ NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 F-f 7/1-13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $229.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure Strong, Motion Fee: IBSEISMICR $2.89 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $4.89 $229.00 TOTAL FEE: $233.89 Revised: 04/01/2014 SMOKE / CARBON MONOXIDE ALARMS 12 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 •FAX(408)777-3333• building cDcupertino.org _Permit No. Address o t(.nr,2 #of Alarms Smoke: Carbon Monoxide: PERMIT,CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE . HAS BEEN�� +�AND RFTITRNED rT0 TI-IE�BTIIL�ING�?IVISION 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 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 Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) 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: h-t 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 have been tested and are operational, as of the date signed below. 1 have read and agree to com ly with the terms and conditions of this statement Owner(or Owner Agent's)Name: Si nature...:. . `.. ... ....." 'C................J......... Date �..... Contractor Name: / / - r� c./ Si nature........ Lic.#..( /..... ..... ...Date:6.....�L Smoke and CO form.doc revised 03/18/14