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B-2016-2146 CITY OF CUPERTINO BUILDING PERMIT. BUILDING ADDRESS: CONTRACTOR:. PERMIT NO:B-2016-2146 20387 CLIFDEN WAY CUPERTINO,CA 95014-4460(369 37 013) SUNWORKS UNITE_ D INC ROSEVILLE,CA 95676 OWNER'S NAME: JUNG DONALD T AND YOUNG M TRUSTEE DATE ISSUED:06/16/2016 OWNER'S PHONE: PHONE NO:(916)409-6900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class SOLAR Lic.#441690 Contractor SUNWORKS UNITED INC Date 12/31/2016 X BLDG —ELECT _PLUMB T I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirmunder penalty of perjury one of the following two declarations: (N) 12 PANEL ROOF-MOUNTED PV SYSTEM(4.14 KW) 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-UPGRADE PANEL(200 AMP)SAME LOCATION-ISSUED Compensation,as provided for by Section 3700 of the Labor Code,for the 7/20/2016 performance of the work for which this permit is issued. i 2,0%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:$20000.00 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 369 37 013 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 appl` nt u derstand nd will comply with all non-point source regulation er the upertin unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature's Date 07/20/2016 Date: _Z, 4 ", OWNER-BUIL 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. 1,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:07/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1.. 1 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. 1 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. 1 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 Areauah Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino unicipdi Code,Ch a 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S chons 25505 155331 and/2W4. Labor Code,I must forthwith comply with such provisions or this permit shall �~ i' be deemed revoked. Owner or authorized agent -� APPLICANT CERTIFICATION Date:07/20/2016 I certify that I have read this application and state that the above information is CONSTRUCTION G 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,ON 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. 1 understand my plans shall be used as public records. Licensed Signature Date 07/20/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISIO ef 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 )B (408)777-3228'FAX(408)777-3333-building(ftupertino.org CUPERTINOZU/6 21 L 6 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI. REVISION/DEFERRED ORIGINAL PERMIT# PROIECT ADD SS -3,16 /7 ` /� � 3E-MAIL �^y / ONAME P OT D D ZJ 7 - t/x7 I/�O E✓MAIL/ STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME / �y le � ,-S V 2 = PHONE _ - -01 31 E-MAIL ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER r J(,//�G�� LE�Iv E� BUS.LIC# 1' -1- 7 G COMPANYNAME E-MAIL FAX Is L)1-1 STREET ADDRESSs t' -Cl CITY,STATE,ZIP , -Y7 �� PHONE � P� , ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 12„ d r ' 2 1 m EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES - USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: - IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN - TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below,I certify to each of the f In I am the property owner or authorized agent to a roperty owner's behalf. I have read this application and the information I have prod ed is corn t. I have r the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tokbirWiny,ns ction. I a e represen fives of Cupertino to enter the above-identified Zerty for inspection purposes. Signature of Applicant/Agent: Y, Date: 2 SUPPLEMENTALATIO RE UI Q �,�.ELAN.C.,HECIf TYPE ,RourmTc si>I,..�.., u. _New SFD or Multifamily dwellings: Apply for demolition permit for �°:avEx-T�cvrn�rTi<1R © Bun.D>�vG�A�v � �, existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑:-sXP121 SSs ` ❑xfiLA}1NINJ ANREYTELV Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTATUTARD y ❑ I'IBIdC 14flZtIr5 form if any Hazardous Materials are being used as part of this project. ❑, A2EDEPT, Copy of Planning Approval Letter or Meeting with Planning prior to ❑'NIAJOB Y Ii ❑ S HIITARY W"R DISTRICT submittal of Building Permit application. ENVIRON�,HE LTIT„ BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2146 20387 CLIFDEN WAY CUPERTINO,CA 95014-4460(369 37 013) SUNWORKS UNITED INC ROSEVILLE,CA 95676 OWNER'S NAME: JUNG DONALD T AND YOUNG M TRUSTEE DATE ISSUED:06/16/2016 OWNER'S PHONE:408-257-1186 PHONE NO:(916)409-6900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-1 0.8 Lie.#441690 Contractor SUNWORKS UNITED INC Date 12/31/2016 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: (N) 12 PANEL ROOF-MOUNTED PV SYSTEM(4.14 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 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:$20000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 36937 013 and state laws relating to building construction,and hereby authorize 369 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 un stands and will comply with all non-point source regulations per Cup rtino M M ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6/16/2016 Issued by:Abby Ayende Date:06/16/2016 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: 1. 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(Scc.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:6/16/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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,Chapte 9.12 and exemption,I become subject to the Worker's Compensation provisions of the, the Health&Safety Code,Sectio 25533,and 25 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: _ APPLICANT CERTIFICATION Date:6/16/2016 I certify that I have read this application and state that the above':information is ON TR CTI L INA E 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. 1 understand my plans shall be used as public records. Licensed Signature Date 6/16/,2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION 0COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 AE CUPERTINO (408)777-3228•FAX(408)777-3333•building(&cupertino.org _�Io ^— 2-`,t, PROJECT ADDRESS a ^ n C APN# OWNER NAME elkof � p PHO `,��J� — E-MAI I ` �V v AG ..� STREET AJ1D ` CITY,STATE,7�IP/ FAX �/ 014. CONTACT NAME 6�1 P{iO,NE _ E-MAIL STREET DDRESS �r. i `, ��, CI ,STATE,ZIP ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONFRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAM ^ IC E N R LICENSE TYPE COMPANY NAME \0E-MAIL SAQ r FAX STREET ADDRESS `�^ �� CI ATE,ZIP C } b-3 SM ARCHITECT/ENGINEER NAMES.,,, 4\ ®r � LICENSE`NUM1v ��C B S.LIC# .�, l COMPANY NAME E SSU _ FAX STREET A 1?AE CITY,ST ,ZIP ` P& �V� J USE OF '�3SFD or Duplex ❑ Multi-Family tAN JECT IN WILDLAND h PROJECT IN STRUCTURE: (❑ Commercial I INTERFACE AREA ❑ Yes V0 FLOOD ZONE ❑ Yes ❑ No LAR PANELS I ❑ ELECTRIC VEHICLE CHARGING S ATION FEJ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: ;e),_ KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK b � 1C J S c RECEIVED BY: Oulu 04MLL, By my signature below,I certify to each/f the follo ing: I am the prop owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have ovided is orrect. I have read Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tob ildin co truction. utho' presentatives of Cupertino to enter the abov identi£Z;d property for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INF RMAT QUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER w ❑ EXPRESS x V w ❑ STANDARD 5 ❑ LARGE 0. I ❑ MAJOR P VApp_201 1.doc revised 03/16111 Y - F I 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 building Qcuperti no.org Permit No. Address 9J— C—C..e �0 #of Alarms Smoke: ' �' Carbon Monoxide: FPERIVIIT CANNOT BE FII�ALED-.AND COLLETED U1�TIL THIS CERTIFICATE : .,....zs -_:.,�r_..r _.a-;mem.—.; .,...,.-�--tee..- •a:�==�v... - .�,�.,, z�cr<-.�sm.� -,sic- .v:�.-.,•aao�e�r�,,..a--»gym,., ...�. ..,;a�...,.. ...�..� .......,... .. .� -.u, ...-,�.-r,. PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314,2013 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, CRCSectionR314 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) On every level of a dwellin 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: x . ...0-4(: ur���C� Snate ... ..... ._.. .................Date: Contractor Name: �5 Of C" nelz � Signatur is Date: Smoke and CO forrn.doc revised 03/13/14 ,r F WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTIINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)-777-3228•FAX(408)777-3333 buiiding(d_)cupertino.org j r Owner Namea J l j� �yr Permit No. e "' Address Fes C.A 7�(�� ✓ }� r _ 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. pfNo 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? El 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 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. iNo 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 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: 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 C lfornia Green Building Standards Code,and manufacturer's installation requirements,and that the water-co e g p ing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: ;` v I , Upon completing and signingi this Certificate,please return I to the Building Division in order to final your building permit. SB46 7 2015.doc revised 08/26/15