B-2017-1906 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: • CONTRACTOR: PERMIT NO:B-2017-1906
10331 STOKES AVE CUPERTINO,CA 95014-1246(326 47 039) CLEAN SOLAR INC
SAN JOSE,CA 95112
OWNER'S NAME: HO WAYNE WAN-CHUAN AND FRANCES SHANG-WEN DATE ISSUED: 11/07/2017
OWNER'S PHONE:408-857-1380 PHONE NO:(408)217-8876
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10. Lic.#910849
Contractor CLEAN SOLAR INC Date 02/28/2018 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)23-PANEL ROOF MOUNTED PV SYSTEM(7.68 KW);(N)SUB
I hereby affirm under penalty of perjury one of the following two declarations: PANEL(60 AMPS)
1. have and will maintain a certificate of consent to self-insure for Worker's
I
�i �r er pensation,asprovided for by Section 3700 of the Labor Code,for the
perfoee 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:$29525.00 •
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 32647 039
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,cost , - . - .enses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against'said City in of the granting of this permit. WITHIN 180 DAYS OF.PERMIT ISSUANCE OR
Additionally,the applicant understands and =amply wit .il non-point
source regulatio ST-r the Cupertino M cipal code, -ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
f Signatu; _ - -� Date 11/7/2017 Issued by:AbbyAyende
IP Date: 11/07/2017 ,
0 OAF DER DECL;_;_• 0 L .
I hereby'affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following,tworeasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is
1. i ;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:11/7/2017
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 •
iperformance 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
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 hazardou
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 A •.Air Quality Mana l.::•nt District I •
' "Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the CupBrtin•Municipal Code ha•ter 9.12 and ,'
'exemption,I become subject to the Worker's Compensation provisions.of the the Health&Safety Code, ectio s s 25505,25533 :i . 534.
Labor Code,I must forthwith comply with such provisions or this permit shall S,
be deemed revoked. OiwO er.or authorized agent: '� -
APPLICANT CERTIFICATION Date:11/7/2017
I certify that I have read this application and state that the above information is 'Mgt.a. . . ►n A . . _ '
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that tKnstruction 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 ubon,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 11/7/2017 Professional
'
\� / ALTERNATIVE ENERGY PERMS; APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
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. 4,41.19,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(c�cupertino.orq
CUPERTINO
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OWNER NAME t' ifte./ 44)
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❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT TRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT
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CONTRACTOR NAME "CfLICENSE NUMB LICENS / ) BUS. k 6-7D6-7DYO c 1 0
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ARCHITECT/ENGINEER NAME ` (//7/ LICENSE NUMBER J�r BUS.LIC#
COMPANY NA E-MAIL FAX
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USE OF fFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial URBAN INTERFACE AREA 0 Yes Q FLOOD ZONE 0 Yes� I\lo
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LAR PANELS 0 ELECTRIC VEHICLE CHAR G STATION I 0 SOLAR WATER HEATING 0 OTHER:
FOR SO R PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TO;;LI597,31kc,
DESCRIPTION OF WORK
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By my signature below,I certify to each of th- ollo. ng: I am the propert . -or au 6•orized agent to act on the property owner's behalf. I have read this
application and the information I have provi..-d• correct. I have read th• I ption• Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin; f•i lrrr g,onstruction. I au--; • - e.esentati of Cupertino to enter the above-identifiededproperty for inspection purposes.
Signature of Applicant/Agent: _ _ "-. ' A Date: �(
; E NTAL INFORMATII REQUIRED '` Q,
., OFFICE USE ONLY ,, ,. w .
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PVApp_2011.doc revised 03/16/11
COY
CUPERTtNO
PURPOSE
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 • buildinana.cupertino.org
P;h R1VIllT CflT,BE FINALED= IAYTIL TIIS CRTIICAT IA:BEEN.
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section 8314, 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
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
I 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 907.2.114 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 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 signe
Address:
d below
.r1«S � /l✓? �i Permit No. �������
s
Specify Number of Alarms it Smoke Alarms # Carbon Monoxide Detectors
I haves rPP(Y anri aaree fn comniv with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
v
QVIQ1 ilbi `-1,'{7
Signature . . ....... .............. .... Date:
Contractor Name:
Signature Lic.# Date:
Smoke and COforimdoc revised 0111012017
` / WATER-CONSERVING PLUMBING FIXTURES
(1.2k OWNER CERTIFICATE OF COMPLIANCE
4451./ns,„ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinqAcupertino.orq _
Owner Name (hair/e Permit No. 0 17- / a6
Address /CZl Jrr�kes A✓e -
Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbmg,installation of water-conserving plumbing fixtures is not technically feasible?
0 Yes Civil Code Sections 1101 1 through 1101.8 do not apply
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
pc-No Go to Question 3
3 Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
Ar No Go to Question 4
4 Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994
Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
pt Yes My real property is built and available for use or occupancy on or before January 1, 1994
Civil Code Sections 1101 1 through 1101.8 apply Check one of the three following statements and sign
bottom of form.
5 Please check ONE of the following:
Xl My property is a single-family residential real property See Civil Code Section 1101 4
On and after January 1,2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property See Civil Code Section 1101.5
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property See Civil Code Section 1101.5
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101 1
through 1101 8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
ntable on the following page. a _
7 -
Owner or Owner Agent's Signature: 4 Date. 11111-
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15