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15090191CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6370 BLACKWOOD DR CONTRACTOR: CLEAN SOLAR PERMIT NO: 15090191 OWNER'S NAME: SHIM QIU OWNER'S PHONE: 4086566570 1445 KOLL CIR STE 109 1 DATE ISSUED: 09/29/2015 SAN JOSE, CA 95112 1 PHONE NO: (408) 217-8876 7 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ (�I ` INSTALL (N) 8 PV PANELS (2.68 KW) License Class t�Lic. # r Q' -C 9 Contractoru`L - sa f &_46 Date 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: t. l 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 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. 1 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 n - oint so per the C rtino Municipal Code,/Sect/ion 9.18. Si atur Date_ ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: i. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ($ec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: t. 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. 1 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. 1 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. 1 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. Date Sq. Ft Floor Area: I Valuation: $16154 APN Number: 36917050.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b_ . Date:TI �� 1 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 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.I2 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, S tions 25505, 25533, and 25534. 9?-Itl Date: CONSTRUCTION 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTI NO ALTERNATIVE ENERGY PERMIT APPLICATION A& mmm COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(a,cuoertino.org isv�lv�a 1 APN 4 ]� PROJECT ADDRESS -�-(�LJC�O� B� I V O 01 KERNAhIE i PIjO� G Y� E-MA11- STREETADDRE C STATE I`PF.AX CON7ACT NAA9E � rtit C 1 PHO t E� /�� 7` E-MAIL STIjt;tffI L-' L C % C�A1 'r�J S FAX ❑ 011R.MER 4-+ 014'TcR-BUILDER ❑ OwN=R AGENT kON7RACT0R ❑ CON7R0.CTORAGENT' ❑ ARCH = ❑ ENGIN-EER ❑ DEVELOPER ❑ iEN,a,IIT CONTRACTOR NATE r LICENSE 1\7-14BER Q LICENI TI BUS. LIC R CON/TAN'Y NAME + E-MAIL FAX $TREcT/}j CITY, STATE, ZC3q-- J � d-1 -7 ` ARCHETFCTlENGDNEER N.AMB LICENSE NUMBER BUS. LIC' CONgANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF KL SFD Or Duplex ❑ 1Iult1-Fam ly PROJECT IN WILDLAND PROJECT IN STRUCTURE: ( ❑ Commercial URBAN INTERFACE AREA ❑ Yes �No FLOOD ZONE ❑ Yes &ATO NcaLAR PANELS ❑ ELECTRIC VEHICLE CYARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/L:NI T S: KILOWATTS (COMMERCIAL. ONLY): � � � TOTAL VALUATI ON: J DESCRIPTION OF WORK By my signature below, I certify to each of the follo ng: I am the property owner or authorized anent to act on the property ,half. I have read this application and the information 1 have provided is ect. I have read t Description of Work and�verify it is accurate. I agree to comply with all applicable local ordinances and state ]a a s relatin t b con ruction. I authorize resentatives of Cupertino to enter the above 1i�d�en/tifie prop for inspection purposes. �. S ienature of Applicant/Aztnt: Date: ((% "1 ( P LEM L RITFOR,IATION REQUIRED — Y - :-� OFFICETi�EA\ZY `� OVER TH1sCOITn'�'£R.t � �_ ❑ ES PR$SS s '_ gx-D8 5 �TANDARII t v ` a � ❑`LARGE � `� � P E4pp_2011. doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 6370 BLACKWOOD DR DATE: 09/29/2015 REVIEWED BY: PHUONG APN: 369-17-050 BP#: ! 01 C *VALUATION: 1$16,154 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: Suppl. PC Fee: (E) Reg. 0 OT PENTAMATION PERMIT TYPE: SOLAR -RES WORK INSTALL N 8 PV PANELS 2.68 K SCOPE ..:'k NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Metrirt. Pt/'_ )_ 1rhPCP fPPC arP haQPd nn tiff nrPliminary infnrinntinn ava11ah1P and arP nn1V an P.QtZmatP_ rnntart tho nPnt fnr addn'1 into - FEE ITEMS, (Fee Resolution 17-053 Ef . 7/7/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $236.00 Alternative Energy System 1PxOTOVREs Photovoltaic System Suppl. PC Fee: (E) Reg. 0 OT FO.01 hrs $0.00 PME Plan Chock: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (E) No $0.000 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 Strong Motion Fee: IBSEISMICR $2.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.10 $236.00 TOTAL FEE:: $239.10 Revised: 07/02/2015 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO CA 95014 3255 jam]:� FILE CUPERT(NO/7 j T- � (408) 777-3228 •FAX (408) 777-3333 • buildingcupertino.org 7 J% (J(/ / Owner Name �,1 �� a i.-- Permit No. Address 63io6L,1 vJ ir< 1. 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. XNo 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 plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ 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. No Go to Question 3. 3. Is water service pennanently 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. XNo 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. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. Please check ONE of the following: 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 110 1. 1 through 110 1.8, 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 table on the following page. a I Owner or Owner Agent's Signature: /%L ;.!7� Date: 1 L-' / 1 tai / J T innn mrnnletina and sinninn this Certificate_ nlea.se return the Buildine Division in order to final vnur huildin¢ nermit SB407 2015.doe revised 08/26/15 CUPERTINO 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 W-cupertino.ora FILE Z_M_ E! M, Permit No. ISD "1 Address 6 170 9 IAI k,,,,J D, # of Alarms Smoke: H Carbon Monoxide: 3 PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 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 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 have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: �] Si nature. .. 1.{ ................................................................................ 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