B-2016-2246 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2246
1151 STAFFORD DR CUPERTINO,CA 95014-4968(362 06 020) POCO SOLAR
ENERGY INC
SANTA CLARA,CA
95054
OWNER'S NAME: HO FRANCIS SUNG NGOR AND HSU EMILY DATE ISSUED:06/30/2016
OWNER'S PHONE:408-930-2812., PHONE NO:(408)970-0680
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SOLAR Lie.# 9 6
Contractor POGO SOLAR ENERGY INC Date 06/30/2018 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)16 ROOF MOUNTED PV SYSTEM(5.20 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.
z. 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:$29539.00
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 362 06 020
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 Cup rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
CASignature Date 6/30/2016 Issued by:AbbyAyende
Date:06/30/2016
OWNE -BUIDER 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/30/2016
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
z. 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 thispermit 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 Municip Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code Sectio s 5505, 533,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:6/30/2016
1 certify that I have read this application and state that the above information is CONSTRUCT ON LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a con truction 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 Flame
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 30 2016 Professional
I
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTlNO (408)777-3228• FAX(408)777-3333• buildinci(aD-cupertino.org
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PROJECT ADDRESS Fo APN#
OWNERNAME Io, PHONESff9 2�� I� E
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STREET ADDRESS I I�SShAFF0f-0
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CONTACT NAME PH E-MAH /
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STREET ADDRESS W/ 016ell/r5- F
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13 OWNER 11 OWNER-BUILDER ❑ OWNER AGENT
CONTRACTOR ❑CONTRACTOR AGENT (❑�ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME(J6C0�f9 _ LIC SENY9v LIC ff E BUy� C l
COMPANY NAMEfo SG �l�C . E-MAIL FAX
STREET ADDRESS 33y� ` CFF] t E /s,� /J ��/, PHONE �A� e6 p
ARCHITECT/ENGINEER NAME LICENSE NUMBER 6 (a((^ (�J'1 V BUS.LIC# o �/
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD r Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: [ItllIIlercial URBAN INTERFACE AREA ❑ Yes /No FLOOD ZONE El Yes Lf No
3(OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANEL ER OF PANS/Ulyl S: ^ � KILO WATTS OMMERC AL ONLY): TOTALMI"
TIO
DESCRIPTION OF WORK n
RECEIVED BY:
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 beh lf. 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 to bilil n on�cfion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: Date:
SIPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
U
.za7 ❑ LARGE
a
❑ MAJOR
PVApp 2011.doc revised 03/16/11
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SMOKE i CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
IR' 1�t3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(okupertino.org
Permit No. moi ,
Address , i ► ( . #of Alarms Smoke: Carbon Monoxide: 1
PER1VrITy cAN OT BE k INALED AND CONWLETED UNTO THIS CERTIFICATE
�' Ati7EE� iiE
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PURPOSE
This affidav't 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
i
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 larms 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
bedroo (s)
On every level of a dwelling unit including basements X X
Within Bach 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 Sectio 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
l alarms which must be connected to the building wiring.
1
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.
have read and agree to cot
ppiywith t terms and conditions of this statement
Owner(o�Owner Agent's)Name:
Signature............ . .............. ... ...... .......-............................Date: .............
Contracto Name:
cam. 'Lc�_
Signature..... Lic.# .6AO....Date: ..........
Smoke and CO foJm.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDINGDIVISION
10300 TORRE AVENUE CUPERTINO,CA95014-3255
CUPER INO
14.08)777-3228•FAX(408)777-3333 building(a)cupertino.om
Permit No.
Addfess
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
.K 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
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Yes C[vil 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.
-E4No Geo to Question 3.
3. Is water sery Ice permanently disconnected for your building?
❑ Yes C vil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
JL No Gp to Question 4.
I
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.
L Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bttom of form..
5. Please check ONE of the following:
My propeirty 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
propertydergoes alterations or improvements).
El' My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and af ter January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or be re 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
improverrlents).
My propel is a commercial real property. See Civil Code Section 1101.5.
On and a ter January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On orb fore 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 own r 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 110 .8,the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation r quirements,and that the water-conserving plum}. ing fixtures comply with the requirements as indicated in the
table on the b1lowing page.
Owner or Ow9er Agent's Signature; Date: 0 _1e\ G,
Upon co pletingsigningd this Certificate,please ' the Buildi gg Division in order to final your building permit.
SB40 7 2015.doe revised 08126115
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