B-2017-1692 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1692
10448 VISTA KNOLL BLVD CUPERTINO,CA 95014-1036(326 13 061) EARTH ELECTRIC
INCORPORATED
SAN JOSE,CA 95108
OWNER'S NAME: KUMAGAI ROLAND N AND BETTY J TRUSTEE DATE ISSUED:09/29/2017
OWNER'S PHONE:650-868-2078 PHONE NO:(408)609-0888
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:B Lic.#1003783
Contractor EARTH ELECTRIC INCORPORATED Date 05/31/2019 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:
ROOF MOUNTED SOLAR SYSTEM(24 MODULES)(7.68 kW);
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL(N)SUB-PANEL(100 AMP).
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REMOVE 100 AMP SUB PANEL-ISSUED 10/11/2017
mpensation,as provided for by Section 3700 of the Labor Code,for the
• ' erformance of the work for which this permit is issued.
. Yv+ t 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:$26960.31
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 13 061
representatives of this city to enter upon the above mentioned property for
inspection purposes. (VVe)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 Municip-I-Code`-action 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
€atur- ate 10/11/2017 Issued by:ABBYAYENDF
- Date:09/29/2017
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:10/11/2017
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
s. 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 he Health&Safety Code,Sections 25505,25533,and 25534
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 0 'ner or authorized agent:
APPLICANT CERTIFICATION ate:10/11/2017
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.
Licensed
Signature Date 10/11/2017 Professional
•
CONSTRUCTION PERMIT APPLICATION
\ I / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION • B
0: ` 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
yi.1p:''''.
J
4, s (408)777-3228 • building@cupertino.org PEMIT AB../..;.9.49/7 - /�r�7�
CUPERTINO REV# i DEF#
0 NEW CONSTRUCTION ❑ADDITION ALTERATION ElT.h ❑MEP ❑RE-ROOF ti SWIMMING POOL/SPA '
.}
PRO)ECTADDRESS 0 ti j J? ' /I .*O � -h of I skA.o ' APN#, 5g • /3
'.' , /
OWNER NAME �o L � �rl„y i�I-n PHONE (go ...�6?_1,,.7,. MAILw\�1.jowi r o �,(
STREET ADDRESS : 0 •j I ��) \A 3 ti Qli GACRY,STATE.ZIP 1, ^ _q, Clot c)
5 0(ct
CONTRACTOR NAME ElOWNER-BUILDERCOMPANY NAME LICENSE NUMBER W LICENSE TYPE .
irvkatkhvt.v Anitiell feu fa-ec c 10039- cl 3 C- I b, eD
STREET ADDRESS CITY,STATE,ZIP
1. -.0 2..- L > n Av-e 443 z 3 S 7Yos•-e., CA G 1ZG
E-MAIL ,�` \/�..,�,,L\_..d.ecbt. PHONE Loo Q ,.r 5(oQ , l Z 4 9 BUS:UC N ._„1„4„ 3 '33
❑ARCHITECT ff..OWNER ❑OWNER AGENT El CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT 1S{
CONTACT NAMEE-MAIL
I \ I.CVYUi, sin-eery1 cf G'�—e\ech7C'• d
STREET ADDRESS I rl r iteCRY,STATE I�p St, CA 'PHONE�(DS " 5T
IA -2z 1 1
DECRIPItDN -- --�(�. — - .._ ,. t 4. • _ CIj .
Te
e�to d aVvt5u avier--
.I
.1,, II. '
1. 1 ,
• JNGLE-FAMILY/DUPLDX ❑MULTI-1RAMILY ❑INDUSTRIAL 0 COMMERCIALI
EXISTING USE EXISTING SP NEW FLOOR SF PORCH SF DECK Sr DEMO SF STORIES II TOTAL NET SF USE TYPE OCC ,SQ.FT, VALUATION(5)
REMODEL i REMODEL KITCHEN I REMODELOTHR GARAGE ❑ATTACHED I
BATHROOM SF. 'SF 1 i 1 } SF SF 0 DETACHED 1l' I
IIXISING i' i❑;YES „i sICHLER 0 YBS,:i.... YES II i
FIRE SPRINKLERS, B 1 '' SECOND STORY ADDITION ❑
'SECOND DWELLING , I
DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER '
UNFFS I 11NIT ADDITON 1 'I' ❑NO id
1 SI' I, I
POOLS" ❑IIFIDSRGLASS,I0'VINYL=LINED;I❑IGUNITE ❑PREFABRICATED
I.
POOL-SE II, ...I SPA Sr I SPA ATTACHED❑YES 0 NO I.TOTAL-SF :.I
91 I ' 'R IVEDD I j TOTAL VALUATION:
In
COniaolc, or Mulif•FgNud,Bu,Jd,nAs wflll PHI'ffC Se!i,sins Pools roff1111Ts Doporinout o`Envirp,up inl Hratll approval '� 1 1 1 I I•,1
�/W
RE-ROOF EXISTING R001;'TYPE: ❑BUILT IW ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES E E OTHEi.
R(SPECIFY) ' •
REMOVE/REPLACE❑NO I IP NO "1 1 PLYWOOD ❑V" ❑3/8" PLYWOOD TYPE: ., I PITCH: ROOF CLASS
Q YES I if OP LAYERS 'I I I k THICKNESS❑5/8" OTHER__ DOSS 0 CDX OTHER ' •I2 A
PROPOSED ROOF TYPE:❑BUILT;UPROOF,DiSPHALTSHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER
"Provide a signed copy of the Cuperti O's Tear-Off Policy SP Aof SQUARES
By my signature below,I'cectify to eaehl4ii 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 Woil<and verily itis 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 ac• • edge and authorize all information contained on this application form
to be made available for public rP,'^.a I %� �o ��r7
Signature of Applicant/Agept "' 6jG', !d,t,_: - Dater f`P�C _
SUPPLEMENTAL INFORMATION REQUIRED , .
*Nei SFD/Second Dwelling Units/Multifaniuly Dwellings;A Demolition permit is required prior to issuance of a building permit for all neva construction.
*Commercial Buildings: Provide a complleted 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. I 'I!, '
*HOA.Provide)a letter of Tapp oval from the Horne Owner's Association
BldgAjip._2017.doc revised 08/01/17 '
,
• X11 ! Ii .
Ii'
•
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1692
10448 VISTA KNOLL BLVD CUPERTINO,CA 95014-1036(326 13 061) EARTH ELECTRIC
INCORPORATED
SAN JOSE,CA 95108
OWNER'S NAME: KUMAGAI ROLAND N AND BETTY,J TRUSTEE DATE ISSUED:09/29/2017
OWNER'S PHONE:650-868-2078 PHONE NO:(408)609-0888 •
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#1003783
Contractor ._: _-. ► •: •s • Date 05/31/2019 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter9(commencing •
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ROOF MOUNTED SOLAR SYSTEM(24 MODULES)(7.68 kW);
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL(N)SUB-PANEL(100 AMP).
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$26960.31
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 13 061 R3
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.
Signatur4. Date 9.29.17 Issued by:SEAN HATCH
Date:09/29/2017
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 isnot 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:2 29.17
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 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:9.29.17
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 norp-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 9.29.17 Professional
/ CONSTRUCTION PERMIT APPLICATION
V/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
A' s (40.8)777-3228 • building@cupertino.o g PEMIT#B-'�/7 - /6q�
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION `ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS +0 LI L)( i�ko 4101 I 6Wv^f ` APN# .....?,d ) /3 .D‘:,
OWNER NAME Ratomt ,k, v ^,a (' e,�, PHONE &go M .ce r ....20V-MAIL vilA 14.4.Non cioi��r @ kon
STREET ADDRESS ( la q `O S) ii, j (� ` B CITY, STATE,OP '. AAR f , ee j c 5o(
McONTRACTOR NAME ❑OVWNNEER-BUILDER COMPANY(NAME LICENSE NUMBER LICENSE TYPE
CION1 W4c lq f ll U-ec, C '1003 - cc 3 G- I b , b
ISTREET ADDRESS CITY,STATE, ZIP
T 0 Z- L `cin Ave 443 2"3 scun c&e, CA ° l2
HON
E-MAIL s� p & le1`i, _-C PION E
L-105 - 5(0& - 2. 2.C 1 BUS.LIC 7 - �- _L_
01
❑ARCHITECT OWNER El OWNER AGENT ❑CCO(NNTRACTORAGENT❑ENGINEER 0DEVELOPER❑TENANT
CONTACT NAME',op`_Yl:% I . E-MAIL P\e r&)
�/] Ar - eV ed- c, Vim- ,I► '
STREET ADDRESS1 CITY,STATE, PHONE
2 -V 4�-� ► /tie- cv ' S�
, rpt Lice 5(�� ZL�9
DECRII'TON
I*INGLE-FAMILY/DUPLEX ' ❑MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
•
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED •
BATHROOM SF SF' SF SF ❑DETACHED I
EXIS' FIRE NG 0 YES
SPRINKLERS El NO EICHLER ❑❑YES NO SECOND STORY ADDITION OYES •
NO
DWELLING SECOND DWELLING ❑YES El ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F ,
POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES ❑NO I TOTAL-SF
RECEIVED OTAL VALUA •L:
Commercial or Multi-Fmnilq Buildings with Public Swimming Pools requires Department of Environmental Heath approval �/,a-^, M „+
•
RE-ROOF EXISTING ROOF TYPE: ElBUILT-UPROOF E]ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLE`S%❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF,NO PLYWOOD ❑'_ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #OF LAYERS 1 i THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Fof 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 apphcationi 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 re�o}_d. - •
[ 2
Signature of Applicant/Agent: Date: l -/ :
SUPPLEMENTAL INFORMATION REQUIRED -
,I ,
*New SFD/Second DwellingiUnits/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.. '
*Coinmercial 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-Pro 1 ide a letter of approval!from the Home Owner's Association
1
• BldgApp_2017.doc revised 08/01/17
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinci@cupertino.orq
u• '�1,3 n tii,i . ik a Hy` a' ," ;xa ."s,1�i si.E r 4 'w
'� z Uri t, R{x, ^3.. i p .,"R, I v k Kf'`f.lyr ',r;a�z• ',4,s t v i -t
'� `PER1VITT CA OTE FIl IED) IL TlTS GERTE TCAT'E$AS BEEN ":11 A
23013,-zwAi
CO E E1)� St 1 EI �RET'I Rl\ELY m tT d Gi ll F, ij
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 shallbe 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,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 alarms 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 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 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 specified below have been tested and are operational, as of the
date signed below. - �j
Address: /i0 /faA 9 #I.LGCddrd'i� � child Cj - 9.s l/y Permit No.26/7 16
Specify Number of Alarms: #Smoke Alarms: 1 S' I #Carbon Monoxide Detectors: I (
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
414-A9/ A64 / Signature..W40,0,,.( /\,,.. .. . . Date/ 4
Contractor Name:
1
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017