15110191-FP` CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:' 19991 LA MAR DR
CONTRACTOR: SANTA CRUZ WESTSIDE PERMIT NO: 15110191
ELECTRIC
OWNER'S NAME: DASTOOR DINYAR AND BENATER
2119 DELAWARE AVE DATE ISSUED: 11/30/20I5
OWNER'S PHONE: 4088580081
SANTA CRUZ, CA 95060 PHONE NO: (831) 469-8888
— LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIALlCOMMERCIAL
❑ ❑
INSTALL 16 ROOF TOP FLUSH MOUNTED PV MODULES
License Class '� ' ,� Lic' tff�J (�
(4KW)
Contractor. j° _1 ' Dated 6
I hereby affrrm'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:
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
Sq. Ft Floor Area:
Valuation: $14000
erformance of thework for'which this permit is issued.
e 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
APN Number: 36910041.00
Occupancy Type:
permit is issued.:•
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information. is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS T ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon,the above mentioned property for inspection purposes. (We) agree to save
180 DAY L LED INSPECTION.
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
ssued by: ate:
with all non -point source regulatio s per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18. "1.
Signatpre� Date
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date;
the following two reasons:', I
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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)
I, as owner of the property, air exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Se6.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: "
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino nicipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 255 , 25. 3, d 25534.
a
Owner or authorized agent:'_ Date:
permit is issued.,;' .,; ;
I 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
CONSTRUCTION LENDING AGENCY
become subject to tlie'Worlcer's Compensation provisions of the Labor Code, I must
I hereby affirm. that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
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 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
keep less the City of Cupertino against liabilities, judgments,
indemnifyiand'hatrm
ARCHITECT'S DECLARATION
costs, and 'expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature_; Date
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION AM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVfSION ALI
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building�,7a.cupertino.org 0/
PROJECT ADDRESS 19991 La Mar Drive
`P' # 7 � ( —
0 LI) V �
OWNER NAME
Din ar Dastoor
PHONE
408-858-0081
E-MAIL
STREET ADDRESS 19991 La Mar Drive
CITY, STATE, ZIP Cupertino 95014
FAX
CONTACT NAME Kristi Cassetta
PHONE831-22&-9363E-MAIL
kcassetta@sandbarsc.com
STREET ADDRESS
2119 Delaware Avenue
CITY, STATE, ZIP
Santa Cruz Ca 95060
FAX
831-515-5098
El OWNER 11 OWNER -BUILDER El OWNER AGENT
CONTRACTOR 11 CONTRACTOR AGENT 11 ARCHITECT
11 ENGINEER 11 DEVELOPER El TENANT
CONTRACTORNAME
Sandbar
LICENSE NUMBER
846294
LICENSE TYPE
C-1
BUS. LIC #
SantaYG�IAu' Westside Electric dba Sandbar
E—kcassetta sandbarsc.com
FAX 831-515-5098
STREET ADDRESSCITY,
2119 Delaware Avenue
STATE, ZIP
Santa Cruz Ca 95060
PHONE
83.1-469-8888
ARCHITECT/ENGINEER NAME Sungevity
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
Sam - shoring@sungevity.com
FAX
STREET ADDRESS
66 Franklin Street Ste. 310
CITY, STATE, ZIP
Oakland CA 94607
PHONE
USE OF SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes No
FLOOD ZONE ❑ Yes ❑ No
,STRUCTURE:
ICI SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FORSOLARPANELS: NUMBER OFPANELS/UNITS: O6
`
KILOWATTS(COMMERCIAL ONLY):
TOTAL VALUATION: $14,000
W
DESCRIPTION OF WORK
grid
Installation of a 4kw tied photovoltaic solar array roof mount
By my signature below, I certify to each of the following:
I am the property owner or authorized agent to act on the pi
owner's ave read this
application and the informatio ave vi d is correc
I have read the Description of Work and verify it is accurate.
o comply with all applicable local
ordinances and state laws rel ing to b 'Id g on III Io .
I authorize representatives of Cupertino to enter the above -identified
property for inspection purposes.
Signature ofApplicant/Age t:
Date: 11/30/15
EMENTAL INFORMATION REQUIRED.
oIciL'usE ONLY°
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OVER THE COUNTER
D' •EXPRESS .
❑, STANDARD
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VIONOXIDE RbLl4ftNiS
OWNER CERTIFICATE OF GONIPL6AFICE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTI NO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 o buildingg-)cupertino.org
L/�
PETt1 U T CANNOT BE FINALED AND COMPLETED UNTII, THIS CE]R.`TIF'ICATE
RYAS BE, hN AND RE tUgI jM 'O T� BUA D'I'G IDMSION
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 INFORMA'T'ION
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 iuz 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.
t have read and a4ree to comply with.the terms and conditions of this statement
srAgerW&J. Nam
Sivpa�r.'e. ;.. !'
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CohfFacfdrrName,
ti%rre.�i'ln.T '.. scree. -4.... sic ,3...........�.lfi . ...>' ' Date`: `�. ?3.a
Smoke and CO form.doc remised. 03118114
01
.`
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40 8) 777-3228 - FAX (408) 777=3333 o building a(kupertino.org
Owner Name 11
a ( Permit No. 0
Address V 1 l 1 g 1 L a G �r
1. Is your real property a registered historical site?
❑ j'es Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
U 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 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.
Z,ET'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.
U- 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.
o�Y
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
es 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:
-NP 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 11.01.8, 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.,. ,i') A
I Owner or Owner Agent's Signaturq�;,;,.1 �- 1 \1 y l Datehtic _Jl /� [ j, � I ?,C, I S I
Upon completing and signing this Certificate, please`return it to the Building Division in order to final your building
SB407 2015.doc revised 08/26/15
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