B-2017-1701 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1701
21594 LA PLAYA CT CUPERTINO,CA 95014-4802(356 23 013) CINNAMON SOLAR
TECHNOLOGY INC
. • CAMPBELL,CA 95008
OWNER'S NAME: WILMORE JAMES AAND PATRICIA W DATE ISSUED:10/23/2017
OWNER'S PHONE:408-257-6804 PHONE NO:(408)883-7000
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lic.#976065
Contractor CINNAMON SOLAR TECHNOLOGY INC Date 08/31/2018 X BLDG X 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) 18-PANEL ROOF MOUNTED PV SYSTEM(4.95 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -CHANGE RAFTER SIZE-ISSUED 12/5/2017
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
erformance of the work for which this permit is issued. 1 _
a I have and will maintain Worker's Compensation Insurance,as provided for lby
(...—v °
Section''3700'of the Labor Code,for the performance of the work for which this
' permit is issued. Sq.Ft Floor Area: Valuation:$15606.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.,'agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize I 356 23 013
•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 r;t•ulatior 'erthe Cupertino i unicipal Code,Section 9.18. I 180 DAYS FROM LAST CALLED INSPECTION.
I
e.
S ii,atur: usv I /I> IL D 0 � Issued by:-Kites-ANailurdsar N �1
G- _�` Date:-1.0.1.2-3426-11-e121�111
OWNER-BUILDER DECLARATION I
I hereby affirm that I am exempt from the Contractor's License Law for one of the
-ROOFS:
following two reasons:' 1 All roofs shall be inspected prior to any roofing material being installed.If a roof is
''i. I,as owner,of the property,or my employees with wages as their sole I 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 ownei of the property,am exclusively contracting with licensed Signature of Applicant: _
contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/5/2017
1 1
I hereby affirm under penalty of perjury one of the following three declarations: IALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
,,i. I have and will maintain a Certificate of Consent to self-insure for Worker's 1
•
Compensation,as provided for by Section 3700 of the Labor Code,for the
,''I 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
i . 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 Co ections 25505,25533 Ind 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall t
be deemed revoked. O r or authorized agent: A ;frAa/�/,
APPLICANT CERTIFICATION r, ate:12/5/2017
I certify that I have read this application and state that the above information is I, CONSTRUC(,.._T N LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I 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 12/5/2017 Piceessd
Professional
Veal
�\\1/1� ALTERNATIVE ENERGY PERMIT APPLICATION
�" COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AE
e„ p\ , 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)77.7-3228•FAX(408)777-3333•buildinq(aicuportlno.orq
CUPERTINO
PROIECP ADDRESS ).c7 I J R i, (' APN# -35-613 �r�1
OWNER NAME i -f f 1I .I�� �; OS S- 0 A r E-M w_ W l e d. /'. .
STREET ADDRESS(”) /�f 9 p cf_CITY,S 'rt ZIP ' /, ���/ ? iy^(AX
CONTACT.NAME GII ✓(f ' PHONE ♦ 1/E-MAT r/6
• , eCe ManiC ,, k(f;
ST9ET_AjrpB�C'SSDe./ (f/� /If _ CITY,ST ( �(_ t ir FAX❑OWNER ❑ OWNER-BUILDER ❑OWNER AGENT JI f`'' CONTRACTOR ❑CONTRACTOR AGIYINTF�!` El ARCHITECTCHqCI ENGINEER CI DEVELOPER 0 TENANT
AMEAd 5v LICENSE Nuily.j 606.5- LICENSE TYPt`, //I BUS.LIC if D 1 1"'f`�/7
COMPANYNAMEUV/\(Jl� - IL%-(/ ll�- j f /l / /
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STREET T31RT3S� Del(.1" e •, Y,STATE,ZIP( /} f PHONE�c) rg,3
!C',�J((,JJ �����' YYY (1.� tel,r 1 t,�. js
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC S ,
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE Of :0 SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND � PROJECT IN ��
STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes lr'NG FLOOD ZONE 0 Yes ,1214IVo
SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER;
FOR SOLAR PANELS: NUMBER OP PANELS/UNITS: (? KILOWATTS(COMMERCIAL ONLY): q (� TOTAL VALUATION: /Yi --!�6
sllJ U!
DESCRIPTION OP 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 O>aine s'be)a f. 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. ]agree to comply with all applicable local
ordinances and state laws relating ing construction. I uthori epresentatives of Cupertino to enter the a`-- 'a a fn erIv for inspection purposes.
Signature of Applicant/Agenf \ Ys1 C n Y , Date: i,j�/ r ` v 1
SUPPL NTAL INFORMATION REQUIRED I air':;:..410':::.l ,_r.
3w u =r� .1M i 0 u7 r'' %Tai
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PVApp 2011.doc revised 03/16/11
•
•
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1701
21594 LA PLAYA CT CUPERTINO,CA 95014-4802(356 23 013) CINNAMON SOLAR
TECHNOLOGY INC
. CAMPBELL,CA 95008
OWNER'S NAME: WILMORE JAMES AAND PATRICIA W DATE ISSUED: 10/23/2017 '
OWNER'S PHONE:408-257-6804 PHONE NO:(408)883-7000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-46 Lie.#976065
Contractor CINNAMON SOLAR TECHNOLOGY INC Date 08/31/2018 ' X BLDG X 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)18-PANEL ROOF MOUNTED PV SYSTEM(4.95 KW) ,
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
I have and will maintain Worker's Compensation Insurance,as provided for by
if
it Section 3700 of the Labor Code,for the performance of the work for which this
•
fiermit is issued.
P Sq.Ft Floor Area: Valuation:$15606.00
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 23 013
representatives of this city to enter upon the above mentioned property for l
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 .e he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
S.nat4i J Aid i L/A! 1,4 Date 10-23-2017 Issued by:Kim Dunbar
��i Date: 10/23/2017
OWNER-BUILDER DECLARATION •
'
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS: I
following two reasons: All roofs shall be inspected prior to any roofing material being installed!If a roof is
1. I,as owner ofthe 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:10-23-2017
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,alCertificate of Consent to self-insure-for Worker's
I�� li •� I
Compensation,as provided for by section 3700 of the Labor Code,for the
1 It
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. 1 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
t
be deemed revoked. ,� /
Owner or authorized agent.."1_"_i.!._/ _
APPLICANT CERTIFICATION • Date: 10-23-2017
I certify that I have read this application and state that the above information is CONST' CTI* 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 plansshall be used as public records.
• Licensed
Signature Date 10-23-2017 Professional
\��,/f ALTERNATIVE ENERGY PERMIT APPLICATION AE .
1COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�w=yfi�y 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildincl(a.cupertino.orq
Lct201 -1-- 11D
�9C J APN# .--5,3--62.3 0/
OWNER NAME �• E-M••
STREET ADDRESS / CITY,S rE,ZIP / .0 trA-qs6(1_(,
FAX ✓
Z.-I Y1 I+ p
CONTACT NAME°,r i 5 �� , 'n o , ' i, PHONE ,I� , s, ?`ov E MAI(d J �.
fwy(� /N �C-if r^/l x /, /U"CA___
` NJ�Ja
STTT D$. SS f\ _ I it_ e � CITY,ST ,ZIP JJ(
q FAX Ce121
UU1�/J�.if I Cu;(J ,-.1J.p�f!�'_�
o OWNER /�❑ OWNER-BUILDER 0 OWNERWNAGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT
CONTRACT{�R.NAME-n D LICENSE NIB,6065- LICENSE TYPt BUS.LIC# 3/739
'1/1COMPANY NAME// `W� �/`�/l �A�/� ( ILf(/yl'/� �/f )/y�� �� FFA) /� /�,-,,\
`�` 1`?/x-2/4 -Ci�A-ve
\ SO rY,\ C,t/VY`G�.{ J !iLE�IFO�'P/ `- c c/ cif -, C.4�'"STREE�E�B,B�5D ( , cid STATE,ZIPC Lel// f�nPHOONE r0 �l3 7
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.iLLIIIICC# Q
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SFD or Duplex 0 Multi-Family PROJECT IN WILDLANDPROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes Ro FLOOD ZONE 0Yes 2....."N"-0
•
SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:_ _
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: 1 G KILOWATTS(COMMERCIAL ONLY): I/ 7 (/ TOTAL VALUATION: If/is-606
tl 0 1 I/ J
DESCRIPTION OF WORK '
1 1'IlS I k oe IR 5511C1m- VritILLSs Cailae
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aGl/,,, i„,,,z,>, ," ,,,,moi �� %%/jJ04”
%��1��!'�/ y�%, i!/�, , , -�:By my signature below,I:certify to each of the following: I am the property owner or authorized agent to act on the propertyer's.eha f. 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 t. . : g construction. I•uthori epresentatives of Cupertino to enter the above-id tified p .perry for inspection purposes.
Signature of Applicant/Agent. '_.........4.. // /LtDate: r
AD D
SUPPLEu NTAL INFORMATION REQUIRED / / .//„%A.:.<4/ l'//174
/ � �G//i %%i
� �i � i9� /�y�� iii
PVApp_2011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
` OWNER CERTIFICATE OF COMPLIANCE r 12A-17
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinc cupertino.orq
PERllIABOT BE= NAILEI'i UNTIL TRIS CERTIFICATE:-HAS.BEEF
COMPLETED,SIGNED.AND RETTIT N`rED TO.THE BUILDING D SIGN
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 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,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, alaiiim(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 alarn(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 2.15-1114 P/ Permit No.,8-2.017-470/
Specify Number of Alarms #Smoke AlarmsL ! #Carbon Monoxide Detectors I ` I
I4—
�
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature ....... Date:
Contractor Name: P
0
f Signature . #�.ar Date: 11./.2-1/
0
Smoke and CO form.doc revised 01/10/2017