15100196 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21884 BYRNE CT CONTRACTOR:RAYCO DEVELOPMENT PERMIT NO: 15100196 ,
SOLUTIONS
OWNER'S NAME: SMITH MARCIE L 3541 INVESTMENT BLVD STE 6 DATE ISSUED: 10/23/2015
OWNER'S PRONE: 4084600039 HAYWARD,CA'94545 PHONE NO:(916)284-6667
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
/ / —7 INSTALLATION OF ROOF MOUNTED SOLAR(18.MODULES)
License Cla Lic.# / 0� ( � [ WITH MICROINYERTERS,(4.5 KW).
tContracto Date Z t5 '
I hereby,affirm that I am licensed u e e 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: Sq.Ft Floor Area: Valuation:$6000
�. I have and will maintain a certificate of consent to self-insure for Worker's
Co sation,as provided for by Section 3700 of the Labor Code,for the APN Number:35716141.00 Occupancy Type:
rformance of the work for which this permit is issued. j
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. PERMIT EXPIRES IF WORD IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION°
correct.I 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 Issued by f"y 14 TH Date: X0 °
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 rinit. A '' 1 ,the applicant understands and will comply with
all non-point r e regulations per the ertino Yunicipal Code, ectio'9.18. RE-ROOFS:
All roofs shall be!inspected prior to any roofing material being installed.If a roof is
SignDate / installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
® OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL;ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons: -
�. 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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) I have read the Hazardous materials requirements under Chapter 6.95 of the
2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
construct the project(Sec.7044,Business&Professions Code), compliance with'the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,See 0.25532(,)should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations: Additionally,shquld I use equipment or devices which emit hazardous air
i. I have and wih'maintain a Certificate of Consent to self-insure for Worker's contaminants as'defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain com y iCo a with.the Cupertino Municipal Code,Chapter 9.12 and the
SafetylCde,Sections 25505,25533,and 25534. -
performance of the work for which this permit is issued.:
2. I have and will maintain Worker's Compensation Insurance,as provided for by O or authorized �
Section 3700 of the Labor Code,for the performance of the work for which this _ Date
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,I I hereby affirm that there is construction lending agency for the performance of work's.
for which this pe�nit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed !
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my dans shall be used as public records.
correct.I 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 Licensed Professional
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.
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATIONam2a14n I; -
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-355
AAm
CUPERTI Nfl (408)777-3228 FAX(408)777-3333 buildinaa.cupertino.ora
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PROJECT ADDRESS li
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OWI cRNAD4E I PHO p�� �0 E-MAIL
6371
STREET ADDRESS I CITY,ST E,ZIP t � FAX
CONTACT NAME H l LZ j E-MAIL
STREET ADDRESS CITY,STA E ZIP FAX
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❑ OV,'NE-R ❑ OWNER-BIM-DER. ❑ OV'NERAGE?T 171ACTOR ❑CONIRACTORAG;N7 ❑ ARCHITECT ❑ENGINEER ❑ DF%ELOPER ❑TEN'Amr
5TRA NAI\E RT LICENSE TYPE BUS.LIC
COMPANY'`?AME E-MAIL rAY
}h an r row ea5
STREET ADDRESS j � CITY. PZIP /
ARCHITECTIENGINEER NA1l 1E ) LICENSE NUMBER ! I BUS.LIC R
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COI/iPANY NAME F MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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USE OF FD Or Duplex ❑ h1ulti-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA
Yes 1 N0 FLOOD ZONE ❑ Yes NO
SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION T❑ SOLAR jWATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF LS/UNITS: KILOWATTS(COIN 4MERCI.AI l ONMO: c� TOTAL VALUATION:
DESCRIPTION OF WORK
J
00-N04
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RECFIVEDBY ` .;- v-
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By my signature below,I certify to each of the follol :_I a -the-proper y-c authonzediaeent to act on the property owner's behalf. I have read his
application and the information I ed s correct. I have r_ the Description f Work znd verify it accurate. I a=ree to comply with all applicable local
ordinances and state laws relating o coon. I aut r' representat' s of Cupertino to enter the above-iden'fied prop -ty for inspection purposes.
SienatureofApplicant/Aae� Date' /6
SUPPLEMENTAL Ilv ORMATION REQUIRED
�;�.�=._��-.,.�OFE?.CE'ii�EO'�ZY_-.,.�.t.t- •I�
OF�R.T7H.�COI7I,iTEIt �
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Pi!$pp_2011.doc revised 03116111
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CITY OF CUPERTITTO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21884 Byrne Ct DATE: Id/23/2015 REVIEWED BY: Sean
APN: BP#: VALUATION: 1$6,000 —�
PERMIT TYPE: Building Permit PLAN CHECK TYi PE: Alteration/ Repair
PRIUSE:
SFD or DuplexT PENTAMATION
PERMIT TYPE: SOLAR-RE
WORK Installation of roof mounted solar 18 modules with micrd,inverters 4.5 k .
SCOPE
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A.J
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ech..flan Check t'Tunth. Pian �Pll
r ii; Elea. Plait t"tteck
7'er°ttiit Fee: It rnl..r':r raze,Fee: FL-11111. 1.'c;t atrct Fee:
i
C}�n�� . �r�zat._Iris • Ll
Orher 1'r�tinb Jag?. ILI other Ele e. ht',o. El
lLech. lnslr. Tee: Phvmbt ins, Fee; l Te:. nsls. Fee:
NOTE:This estimate does not include fees due to other Departments(L e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the preliminar information available and fare only an estimate. Contact the Detor addn'l in o.
FEE ITEMS(Fee Resolution 11-053 Ef. 7/1/13, FEE QTY/F !E MISC ITEMS fi
Plan Check Fee: $0.00 1 j# Alternative Energy System
Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System
PME Plan Check: $0.00
I
Permit Fee: $0.00 j
Suppl. Insp.Feer Reg. 0 OT p 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(."onsiruction Tux:
Adi-ninistrative Fee:
Mork Without Permit? O Yes ( No $0.00
Advanced.Planning Fee: $0.00 ! Select a Non-Residential
Building or Structure
Trclvel Doetimentution Fees: i
Strong Motion Fee: IBSEISMZCR $0.78 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 j
SITBTOTAL5 $1.78 $236.00 TO AIs E $237.78
Revised: 10/01/2015
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300TORREAVENUE • CUPERTINO,,CA9501-4-3255.-
;,(408)_.777=3228`--FAX(408)777-3333 • buildino(c)cuoertino.orq '
/4 ' • "
<:-- Permit No. ,
Address � �� `'* O of Alarms Smoke:3 Cene-Carbon Monoxide: Arte)
��;�.,- ��PERMIT�CA,NNOT.BE-7']NALED AND COMPLETED UN.T',IL THIS CERTIFICATE ` '`�
--- �FiAS BEEN fit I-�NF�D 4ND R T+ iTR�NED TO T73E•B-UILDIlI�G D�VISTOI�
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 X X
bedroom(s)
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.
1 have read and agree to comply vrith the terms and conditions of this statement y,
,Owner(or Owner Agent's) Name:
ry Signature.............. . ...
+lF
Contractor Name: -
Signature...............•...................•...............................Lica
_-�.•� - -. .:'..• Date
Smoke and COform.doc revised 03/,18/14
'WATER-CONSERVING PLUMBi G Foci RES
OWNER CERTIFICATE OF C®MPLANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
C U E RT I O 10300 TO RRE AVENUE•CU PERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333^building(Dcupertino.orq
Owner Name NA o a' C i e- L- :Sm,.+k Permit No. 0 S7601 96
Address 1 Y 13 Y/ rk C'. �,ou,-A' �cx-t��-4i rw. QA Ci G7( ��
1. Is your real property a registered historical site?
❑ es 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
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 110 1.1 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.
°`r 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.
)(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 nnprovements 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 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 age. ,
Own er o r Ow n e r Ag e nt's S1gnatu rg,, .�..� A_� -
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