B-2017-1528 •
CITY OF CUPERTINO BUILDING PERMIT •
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1528
940 PROVIDENCE CT CUPERTINO,CA 95014-4028(356 11 057) AFFORDABLE HOME
SOLAR
UNION CITY,CA 94587
OWNER'S NAME: TSUCHIDA THEODORE H AND CYNTHIA BUYCO DATE ISSUED:09/11/2017
OWNER'S PHONE:650-636-5044 PHONE NO:(510)468-8535
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lic.#1006946
Contractor AFFORDABLE HOME SOLAR Date 08/31/2019 X BLDG ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)21 PANEL ROOF MOUNTED PV SYSTEM(6.090 KW)
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
n performance of the work for which this permit is issued.
14`"" 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:$17000.00
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 356 II 057
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 p'cant understands and will comply with all non-point
source regal on p r #1 upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signal ., -- �' ' Date 09-11-2017 Issued by:Kim Dunbar
Date:09/11/2017
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 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:09-11-2017
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
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 33,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall —be deemed revoked.' Owner or authorized age rh1
APPLICANT CERTIFICATION Date:09-11-2017
I certify that I have read this,application and state that the above information is CONS°t': CTION LENDING AGENCY
correct.I agree to comply with ail'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 meritioried property for inspection purposes. (We)agree Lender's Name
tosave 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.
Licensed
Signature Date 09-11-2017
Professional
\a/ ALTERNATIVE ENERGY PERMIT APPLICATION
1�/1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AE
4,5I.,9ss 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(cilcupertino.orq
CUPERTINO F ZO I ^ 12-3
.
PROJECT ADDRESS 9/Io ®rout (74-• APN# '356a I 1 — 0 S F
OWNER NAME .. c (A ( SCLC) i 1 �[iONE a 2 /'�!— y E-MAIL
(�G GL L{ C ( �` fo rh
STREET ADDRESS e" CITY,CITY, STATE,ZIP FAX
`C Pcp V;c(fiCe CIL pe,Arnot C/4 %S-0/Y j
CONTACT NAME/Lief; �fu�eti PHO $ 0`y68.- rr3 E-MAIL �rda6�GIU.v�sd/fiefeu*,/c 1,
STREET ADDRESS p, AC. CITY,STATE,ZIP (t11yr C4 fuSS. FAX
1,62
„r-1405',11,1 ��.� ,.
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT SICONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME / h 6 140 ‘....44,- LICENSE NO o‘P cf LICENSE TYPE BUS.LIC# nO.`,Sy5
COMPANY NAME A-%PJ^ Id / _GA E-MAIL /I J�66�" CPA-f.05 4-/ i FAX ,
STREET ADDRESS C/(/Z {1 4/^ ,4 '� CITY,STATE,ZIJ ,09'l ^I�/ C 0�� PHONF/t,) 4 g4 tJ2S
ARCHITECT/ENGINEER NAMEi�' �"C LICENSE NUMBER llv` C BUS.LICc #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF X SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ,s, No FLOOD ZONE ❑ Yes g1 No
>4OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: Z r KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATIONc$, 3 o O
DESCRIPTION OF WORK
3-011+c, (4-, `LPA Off- -16L- sk—tel u...+eJ (oat s 6,0 90 1 Gil
10 v 9,,s ., u/ C 1) 50 l— ' 4t of (0) C2„.7fr4 Atuer c,,
•
RECEI Y:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p perty 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 ION' construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: „ a,' Date: 0,//1 7--
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W.
0 OVER-THE-COUNTER
a
' Ik'' 0 EXPRESS.
V
' W.t
M '0 STANDARD
zV. 1
, 0 LARGE.'
0.,
❑' MAJOR„ '
PVApp_2011.doc revised 03/16/11