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B-2017-1394 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1394 22339 MCCLELLAN RD CUPERTINO,CA 95014-2768(357 05 047) V B A SYSTEMS INC STUDIO CITY,CA 91607 OWNER'S NAME: TONG HOMER H C AND JOANNE C Y TRUSTEE DATE ISSUED:08/21/2017 OWNER'S PHONE:818-535-9651 PHONE NO:(818)683-4724 • LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#967884 Contractor V B A SYSTEMS INC Date 11/30/2017 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) 14-PANEL ROOF MOUNTED PV SYSTEM(4.13 KW) I hereby affirm under penalty of perjury one of the following two declarations: REV#1 CONVERT D.C.TO A.C.CONVERTER;ADD 14 MICRO 1. I have and will`maintain a certificate of consent to self-insure for Worker's INVERTERS TO BE INSTALLED UNDER SOLAR PANELS-ISSUED Compensation,as provided for by Section 3700 of the Labor Code,for the ji.d:t. 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. Sq.Ft Floor Area: Valuation:$14000.00 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 357 05 047 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. Signa V Date 08/31/2017 Issued by:Kim Dunbar ►. Date:08/21/2017 • OWNER-BUILDER DECLARATION I hereby affirm that I ant 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:08/31/2017 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, 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. 1 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 a. I certify that in the performance of the work for which'this permit is issued,[ 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 device's which emithazardous • 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 agen ,A APPLICANT CERTIFICATION Date:08/31/2017 I certify that I have read this application and state that the above information is CONST° CTION 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 08/31/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION ' COMMUNI'I'Y DEVELOPMENT DEPARTMENT• BUILDING DIVISION _ B 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 4,,,I./5,4 s y.l9s 'I - /3 99 (408)777-3228 • building@cupertino.org PEMIT#B- C1JPERTINO • REV# / DEF# ziNEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS,0 2 E 39 ,Hc C I e fi APN# 2_57 as 0117 7 OWNER NAME , m e,- ���6 PHONE�g' S 7� 9-6'S� E-MAIL STREET ADDRESS ^ CITY, STATE,ZIP �27r9 ^ c // el-1-7/7 a I c/9/. 2-3-a 0 z/ ❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAMELENUMBER LICENSE TYPE S6/Gtr -el y 911 9;6'76'g-el Q.-1 ISTREET ADDRESS< Cf/ �- ` re/ 0 S d CITY,STATE, ! c Ca- ! / 6'®7 - I E-MAIL -�I/y PHONE // BUS.LIC 82/ e/er I°� 9//- sem g6d S2 2 zi S' 0 ARCHITECT ❑OW 'OWNER`GENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAMEr9�_Z. �/ E-MAIL r`, c r - ��� `�ii coin STREET ADDRESS T CITY,STATE,ZIP / PHONE SS-5 '355' 207$ DECRII TON ? ria..... �J /)9 ,/� 6�7L,o . eu . ,.o/G..- rr 'i- _ /i)�,/erl-Pr 7 /� . C_ , /'c/-o /77-- �/-��fe,-.._ 112e"-+ IAvl- /1 h /i �7/1// d SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF i SF SF ❑DETACHED FIREISPRINKLERS 0 NO NG 0 YES EICHLER 0 0 NOS SECOND STORY ADDITION OYES NO DWELLING SECOND DWELLING OYES 0 ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED • POOL-SF SPA-SF I SPA ATTACHED ❑YES -! NO TOTAL-SF ' RECEIVED BY: TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval t�/' // G RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF El ASPHALT SHINGLES I=1 WOOD SHAKES❑WOOD SHINGLES E TILE OTHER(SPECIFY) v REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑1/„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑ YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy sF Hof SQUARES 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 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 relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. �y Signature of Applicant/Agent: 4�''v/ Date: 6/S J' / 7 SUPPLEMENTAL INFORMATION EQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. _ *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter•or Meeting with Planning prior to submittal of Building Permit application., *HOA-Provide a letter of approval from the Home Owner's Association • BldgApp_2017.doc revised 08/01/17 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1394 22339 MCCLELLAN RD CUPERTINO, CA 95014-2768 (357 05 047) V B A SYSTEMS INC STUDIO CITY, CA 91607 OWNER'S NAME: TONG HOMER H C AND JOANNE C Y TRUSTEE OWNER'S PHONE: 818-535-9651 LICENSED CONTRACTOR'S DECLARATION License Class C-1 0 Lic. #987884 Contractor V B A SYSTEMS INC Date 11 /30/2017 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. 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. 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: 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 souMe-regulations per the Cupertino Municipal Code, Section 9.18. Date 8/21/2017 I hereby affirm that I am exempt from the 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, 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: m. 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. 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. 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 8/21/2017 ISSUED: 08/21/2017 PHONE NO: (818) 683-4724 BUILDING PERMIT INFO: X BLDG —ELECT -PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (I) 14 -PANEL ROOF MOUNTED PV SYSTEM (4.13 KW) Sq. Ft Floor Area: I Valuation: $14000.00 APN Number: ' Occupancy Type: 357 05 047 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 08/21/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/21/2017 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 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, Sections 25505, 25533, and 25534. O0'r authorized agent: 8/21/2017 CONSTR CTION LENDING 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 (408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.ord Fj 1-0k "1 30H PROJECT ADDRESS l C /�1 e J/ fin M f� C�� l�f r ` APN n OWNER NAME PHO/ E-11 O S �J J7 STREET ADDRESS CITY, STATE, ZIP 5� / FAX O I' CONTACT NAME /� - FPHON��q,-7E-MAIL / �1 y5/A STREET ADDRESS CITY, STATE, ZIP FAX ❑ OwNER ❑ OWNER-BUH.DER El'OWNIIERAGENIIT ❑ COATRACTOR W CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME M ;' LICEI�ISENTUMBER ` 7�� LIC ET}P� BUS �LIC /7 V ` �J � S STS �S c FAX COMPANY NAME E-MAIL STREET ADDRESS48 I 1_e / `e 1 U�V Lam/! CITY, STATE, ZIPS I / 160 J r PHONE ARCIIITECT,ENGINEERNAME" LICENSENUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ ; SFD, or Duplex ElMulti-Family PROJECT IN VRRLDLAND PROJECT IN STRUCTURE: El ConimCTcial URBAN INTERFACE AREA ❑ Yes [XNo FLOOD ZONE ❑ Yes ❑ NO R2SOLAR. PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELSU HTS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: / o© I' DESCRIPTION OF WORKJ. I ,�' REC£I1 ED BY g 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 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 relating tobuilding construct' n. authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes. j,"I l /i. Applicant/Agent: /fi'liYr Date: Signature of ,&VIQ - SIJPPL'EMENTAL INFORMATION REQUIRED„ oFFicEiJSEoriX,,.,„ �z 1 THE-COiihTER t s P j i Iy4RGE PVApp_2011.doc revised 03116111 CUPERTIE` O SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org V09"ONOT-B19FINE: UN i I TFIS CERTIFICATE .HAS BEl CONI ' ;ETEI3 Alm RF'I ITR_7y D TO_ iiE lA0D 01DWtswN 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 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 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) X X 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 CSC 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 907.2.114 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 hasihave 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% (�f! Address / hd CVP �4 Qd�? , `—A Permit No. ��7'2L ! 3 Specify Number of Alarms: # Smoke Alarms. # Carbon Monoxide Detectors !_- I have read and agree to conlDIv with the terms and conditions of this statement Owner (or Owner Agent's) Name: Signature - ' —� Date:���� Contractor Name: Signature.. .. ...., Lic.# ....... G� DateL.q�� /off U (�57 v Smoke and COfo7777.doc revised 12/15/16 a