B-2016-3162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3162
10560 SAN LEANDRO AVE CUPERTINO,CA 95014-2756(357 05 030) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: SO KWAI-CHUENAND LI WEI 0 DATE ISSUED:11/23/2016
OWNER'S PHONE:408-483-8299 PHONE NO:(650)963-5100 •
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:C-46:B Lic.#888104
Contractor SOLARCITY CORPORATION Date 12/31/2016 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
license is in full force and effect. JOB DESCRIPTION:
(N)12-PANEL ROOF MOUNTED PV SYSTEM(3.78 KW);(N)SUB
I hereby affirm under penalty of perjury one of the following two declarations: PANEL(125 AMP)
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
Aiperformance of the work for which this permit is issued.
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:$8000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to complywith all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 05 030
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 S N "
source regulations pert e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature . " Date 11/23/2016 Issued by:AbbyAyende
Date:11/23/2016
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: 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 of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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 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 SafetyCode, should I store or handle hazardous
Health& Section 25532(a)
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as`fo become subject to the air contaminants as defined by the Bay Area Air Quality Management Districtd
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 ections 25 05,25533,m425534:—
Labor
nd 5534:'Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. O wnerr
or authorized agent:
APPLICANT CERTIFICATION Date:11/23/2016 .
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING A ENCY „..-_.
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. I understand my plans shall be used as public records.
SiSignature Date 11/23/2016 Licensed
9 Professional
1?2,,,, ot,(42.- 31(19_,
•
'1 ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIOAE
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10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
t (408)777-3228• FAX(408)777-3333•buildinq{a cupertino.orq
CUPERTINO
PROJECT ADDRESS 7 O$i0 f / A ®� APN
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OWNER NAME '" PHONE wt..q g3iteti E-MAIgcso
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CONTACT NAME 1<v ja.15 0 PHONE L/06_Lite-
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0 OWNER 0 OWN�E?R-BUI DER 0 OWNER AGENT VNTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 1:1- DEVELOPER 0TENANT
CONTRACTOR NAME/ ..:. „its �. LICENSE NUMBER ro4 LI ENSE TYPE__ BUS.LIC#
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COMPANY NAME - C ;AX
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STREET ADDRESS 3 d g r Je w�//`r� CITY,STATE,ZIP,,4 ;44 4 0 PF(�y1 —9-2 — O�/}
ARCHITECT/ENGINEER NAME 6•� LICENSE NUMBER J I l� BUS.kLIC
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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USE OF )41"SFD OF DU lex ❑ MUlti-Famil PROJECT IN WILDLAND PROJECT IN
- .STRUCTURE: ❑ Commercial URBAN INTERFACE AREA 0 Yes ❑ No FLOOD ZONE ID
0 No
,SOvLAR PANELS ❑. ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTALVALUATION:z10
DESCRIPTION OF WORK �+� c Co/ Th ^ 701
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RECEIVED BY `'",; .• - ' z
By my signature below,I certify to each of the following: I am the property owner or authorized agent to acont the property owner's b-half. Shave 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 building construction. I authorize representatives of Cupertino to enter the above-identi ed properlyfor inspection purposes.
Signature of Applicant/Agent: Date: 1,6
SUPPLEMENTAL INFORMATION REQUIRED { °
0 rOVER;TfE COUNTER
0)7 `PRESS
@ LARGE w " I s
a �
PVApp_201Ldoe revised 03/16/11
--DocuSign Envelope ID:5CAO4AF9-CD67-4A22-8005-73BA69E97E40 ❑
❑ 14 ❑
�/ SMOKE! CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
fQs,. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinnOcupertino.orq
Permit No. 3L-,-2 � �
Address 10560 San Leandro Avenue Cupertino, CA 95014 (#of Alarms(Srnoke) 4 (Carbon Monoxide: 1
PEI 1► CANNOT_BE FINALE])AND COIVIPLETED :NTIL THIS.CERTXF'1CATE
::...........:....
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/.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
bedrooms)
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,alarms)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 theremoval 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: ,—Docusignea by:
KC So (Signature....LSO (Date:)10/16/201.6
Contractor Name: `—A67C40ElFECE406...
Signature Lic.#......................................Date: ....................
Smoke and CO forindoc revised 03118/14
/„
DocuSign Envelope ID:5CAO4AF9-CD67-4A22-8005-73BA69E97E40 ❑ �•
\:(,:c/1 WATER-CONSERVING PLUMBING FIXTURES 0 ❑
OWNER CERTIFICATE OF COMPLIANCE
fit tis 1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CtJPERTI NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(a�ctiAertino.o_r_ci
Owner Name KC So _2-o16-314'1—
Permit Na.
Address 10560 San Leandro Ave, Cupertino, CA 95014, US (SANTA CLARA County)
: .: .'PERMITCANNOT BE:FIlNALED.AN])CO 'LETED UNTIL TMS:CER,TIFICATE
NF AND FT ... DTOTHE:BUILDINGD: ;::.::.:::
Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
Cl Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
r—DocuSigned by:
Owner'Signature: S4 Date: 10/16/2016
® No Go to Question 2.
'—A67C40E1FECE40B...
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.
Sign below and skip the rest of the form.
r—DocuSigned by:
Owner'Signature: W S.6 Date: 10/16/2016
Er No Go to Question 3. --A67C40E1FECE40B
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
r—DocuSigned by:
Owner'Signature: L I sb Date: 10/16/2016
L(No Go to Question 4.
—A67C40E1FECE40B...
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. Sien below and skip the rest of the form.
—n«•Signed try:
7'yJ Owner'Signature: 5Date: 10/16/2016
El Yes '--A67C4OEIFECE4OB._
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. Refer to the attached.
1'1 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 noncompliant 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 nntlt family 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).
LI 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.
38407 2014.doc revised 03/18/14