B-2016-2631CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2631
1122 SCOTLAND DR CUPERTINO, CA 95014-5051 (362 28 019)
GOLDEN BEAR
SOLAR
MEADOW VISTA, CA
95722
O'WNER'S NAME: MAN STEVEN SIU AND FEI YU
DATE ISSUED: 09/01/2016
OWNER'S PHONE: 408-3936863
PHONE NO: (650) 520-9104
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C--46 Lie. #923707
Contractor GOLDEN BEAR SOLAR Date 10/31/2016
X BLDG X 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
c,
license is in full force and effect.
JOB DESCRIPTION:
(N) 10 -PANEL ROOF MOUNTED PV SYSTEM (3.25 KW); SERVICE
I hereby affirm under penalty of perjury one of the following two declarations: ,
PANEL UPGRADE (200 AMP)
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.
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: $14000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
362 28 019
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 Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
J
-
Signature -- Date 09/01/2046
Issued by: Kim Dunbar
OWNER DECLARATION
Date: 09/01/2016
--BUILDER
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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 09/01/2016
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
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 ofthe 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, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, 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: 09/01/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING 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, 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 09/01/2016
Professional
PVApp_2011:doc revised 03116111
Address ) t
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 g building
CcDcupertino.orq
Permit N
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CIRC Section R314, 2013 CSC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family end 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 907.2.115 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be 4stalled in the following locations:
Carbon Monoxide
do not have an att;
CBC Section 420.6
Power Supply: In d -v
In existing dwelling
not result in the rem
space. Refer to CRC
alarms which must I
As owner of the
installed in acco
and California I
below.
us are not required in dwellings which do not contain fuel -burning appliances and that
1 garage. Carbon monoxide alarms combined with smoke alarms shall comply with
shall be approved by the Office of the State Fire Marshal.
ling units with no commercial power supply, alarm(s) may be solely battery operated.
its; alarms are permitted to be solely battery operated where repairs or alterations do
al of wall and ceiling finishes or there is no access by means of attic, basement or crawl
-tion R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
connected to the building wiring.
,renced property, I hereby certify that the alarm(s) referenced above has/have been
h the manufacturer's instructions and in compliance with.the California Building
Codes. The alarms have been tested and are operational, as of the date signed
of f;,; . cf.f.m f
f AREA
SMOKE ALARM
CO ALARM
Outside of each separate
sleeping area in the immediate vicinity of the
X
X
bedroom(s)
Signature ................ .........
On every level of a
�Nvd1lin.g unit including basements
-
X
X
Within each sleeping
room
X -'
Carbon Monoxide
do not have an att;
CBC Section 420.6
Power Supply: In d -v
In existing dwelling
not result in the rem
space. Refer to CRC
alarms which must I
As owner of the
installed in acco
and California I
below.
us are not required in dwellings which do not contain fuel -burning appliances and that
1 garage. Carbon monoxide alarms combined with smoke alarms shall comply with
shall be approved by the Office of the State Fire Marshal.
ling units with no commercial power supply, alarm(s) may be solely battery operated.
its; alarms are permitted to be solely battery operated where repairs or alterations do
al of wall and ceiling finishes or there is no access by means of attic, basement or crawl
-tion R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
connected to the building wiring.
,renced property, I hereby certify that the alarm(s) referenced above has/have been
h the manufacturer's instructions and in compliance with.the California Building
Codes. The alarms have been tested and are operational, as of the date signed
of f;,; . cf.f.m f
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Owner (or.Owner Ageni's
Name.
® , .............
Signature.. ........... .... G✓.. ..... ...... Date: ......
Contractor Name:
e
Lic.# .. Date:
Signature ................ .........
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Address I % G
FIR
ATER=CC SERVING PLUMBING FIXTURES r' I ��,
) ER CERTIFICATE OF COMPLIANCE I s
:OMMUNITY DEVELOPMENT DtPARTMENT • BUILDING DIVISION
0300 TORRE AVENUE • CUPERTINO., GA 95014-3255
108) 777-3,228 • FAX (408) 777-3333 - building a.cupertino.om
' Permit No. 2O l k 24 1
Zz9v MIA
1. Is your real property a re;
El Yes Civil Code Se
14, No Go to Questio
2. Does your real property 1
plumbing, installation of
❑ Yes Civil Code Se
❑ The Iicensi
Skip the rest c
No Go to Questio
3. Is water service permanen
El Yes Civil Code Sec
No Go to Question
4. Is your real property built
b�No My real. prc
Civil Code
❑ Yes My real pr(
Civil Code
bottom of i
5. ease check ONE of the fi
My property is a single
On and after January 1
to be replaced with wat
compliant plumbing f
property undergoes alte
13 My property is a multif
On and after January 1,
plumbing fixtures to be
On or before January 1,
conserving plumbing fi
improvements).
❑ My property is a comm
On and after January 1,
plumbing fixtures to be
On or before January
plumbing fixtures throi
3 historical site?
1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
ie a licensed plumber certifying that, due to the age or configuration of the property or its
ater-conserving plumbing fixtures is not technically feasible?
ons 1101.1 through 1101.8 do not apply.
plumber's certification has been provided to the Building Division.
he form and sign bottom of form.
disconnected for your building?
is 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form,
available for use or occupancy on or before January 1, 1994?
is built and available for use or occupancy after January 1, 1994.
)ns 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
is built and available for use or occupancy on or before January 1, 1994.
)ns 1101.1 through 1101.8 apply. Check one of the three following statements and sign
family resid�fntial real property. See Civil Code Section 1101.4.
2014, building alterations or improvements shall require all non-compliant plumbing fixtures
;r -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
xtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
-ations or improvements).
:milt' residential real property. See Civil Code Section 1101.5.
2014, specified building alterations or improvements shall require non- compliant
replaced with water -conserving plumbing fixtures.
2019, all non-compliant plumbing fixtures shall be replaced with'water-
;tures throughout the building (regardless of whether property undergoes alterations or
�rcial real property. See Civil Code Section 1101.5.
2014, specified building alterations or improvements shall require non- compliant
replaced with water -conserving plumbing fixtures.
1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
=bout 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 spec�fied
above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the curie
t California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements,
nd that the water -conserving plumbing fixtures comply with the requirements as indicated. in the
table on the foll pagiP.
Owner or Owner Agent's S'gnature:
_ Dater
Upon completing�and signing this Certificate, please return it to the Building Division in order to final your buildfng permit.
SB407 2015.doc revised 08126115