B-2017-1395CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1395
10504 MADRONE CT CUPERTINO, CA 95014-6578_ (342 60 022) HIGHLIGHT SOLAR
INC A CALIFORNIA
CORPORATION
SAN JOSE, CA 95117
OWNER'S NAME: LEWIS DANIEL WAND HANNAH S DATE ISSUED: 08/21/2017
OWNER'S PHONE: 650-465-2411 PHONE NO: (408) 489-9213
LICENSED CONTRACTOR'SDECLARATION BUILDING PERMIT INFO:
License Class C --4Q Lic. #960378
Contractor HIGHLIGHT SOLAR INC A CALIFORNIA CORPORATION Date X BLDG _ELECT _PLUMB
04/30/2019 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 JOB DESCRIPTION:
license is in full force and effect. (I) 20 -PANEL ROOF MOUNTED PV SYSTEM (5.8 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
mpensation; as provided for by Section 3700 of the Labor Code, for the
performance of the work;foi 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
permit is issued.
I
APPLICANT CERTIFICATION
I certify that 1 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, tf�i applicant'`understands and will comply with all non -point
source regula i ns per the Cupertino, Municipal Code, Section 9.18.
Our
e Date 8117/2017
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I hereby affirm that ]foam exempt fromithe Contractor's License Law for one of the
following two reasons:
1. 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, Bu smess;&Professions Code)
z. I, as owner of theproper(3; am exclusively contracting with licensed
contractors to construct
the pr9ject(Sec.7044, Business &Professions Code).
I hereby affirm underpenalty of perjury one of the following three declarations:
t. I have,and.wilLmahitain 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.
z. I have and'willmain4in 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
iv
shall not employ ariy person ill any manner so as to become subject to the
Worker's Compensation laws,of Califomia. If, after making this certificate of
exemption, I become'subject,to the Worker's Compensation provisions of the
Labor Code; I must forthwk comply with such provisions or this permit shall
be deemed revoked. F e
PLICANT CERTIFICATIO
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,'andlhereby 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 4which 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. '
Date 8/17/2017
Sq. Ft Floor Area: I Valuation: $17850.00
APN Number: Occupancy Type:
342 60 022
PERMIT EXPIRES IF WORK ISNOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
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 ofApi
Date: 8/17/2017
ALL ROOF COVERINGS' TO BE CLASS "A" OR
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 contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S tions 25505, 25533, and 25534.
O , er authorized agent:
e.11712017
CONSTRUCTION ENDING AGENCY
I hereby 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 A.
(408) 777-3228 • FAX (408) 777-3333 • buildinaCcDcupertino.orcl
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USE OF KSFD or Duplex ❑ Multi -Family
PROJECT IN AgLDLAND
PROTECT IN,
STRUCTURE: ❑ Commrcial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ Yes ❑ NO
SOLAR PANELS'
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR MATER HEATING
OTHER:
FOR SOLAR PANELS. NUMBER, OF PANELS/UMTS: KILOWATTS (COMMEI;CIALO Y): ; ��
TOTAL VALUATION:
DESCRIPTION OF WORK
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ov net's behalf. I have read this
application and the information I have provi d is or rect. I have read the Description of Rork and verify it is accurate. I alepe to comply with all applicable local
ordinances and state laws relating to build' co vction. I authorize representatives of Cupertino to enter the above -id tifierd pr pe rty for inspection purposes.
Signature of Applicant/Agent: Date: S
SU LEI\ NTAL INFORMATION REQUIRED
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PV4pp_2011.doc revised 03116111
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'-i` SMOKE / CARSON MONOXIDE ikLARMS
OWNER CERTIFICATE OF COM LIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BU LDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014- 255
(408)777-3228• FAX(408)777-3333•buildin. • cu ertino.or.
ERM B AI:ED TNT...._.y...._.._..,
,v. TTI AL THIS CERT ! KATE HAS BFEN
1 Cfl PT TE] SIGNED,AND ituruR I3_TO 0-0,403L G➢Ii_SIO N:
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PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 wih Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000 00,CRC Section R314 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: J
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of 1 X X
the 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 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 operjated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no accessjby 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 1
As owner of the above-referenced property,I hereby certify that the alarrn(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 //.&09 M ,i',e,, eys., 72G'. 95-10/9 13
Permit No ��,7 ®
Specify Number of Alarms: #Smoke Alarms: _en #Carbon Monoxide Detectors 1 r 1
I have read and agr e-to=omply with ti nand con.r:tions of this statement
Owner(or Owner Agent's)Name:
ti 5 Signature ..._ Date:���j��'
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 12/15/16