BLD-2022-1093_SignedPermitBUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: APN: PERMIT NO:
OWNER’S NAME: OWNER’S PHONE:
CONTRACTOR: CONTRACTOR PHONE:
DATE ISSUED: ISSUED BY: VALUATION:
JOB DESCRIPTION:
LICENSED CONTRACTOR’S DECLARATION:
CONTRACTOR: LICENSED CLASS: LICENSED NO: EXP DATE:
I hereby affirm 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 three 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 performance 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.
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 become subject to
the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code,
Sections 25505, 25533, and 25534.
EPA LEAD-SAFE DISCLOSURE
An EPA Lead-Safe Certified Renovator will be responsible for this project.
Certified Firm Name: _____________________________________________ Firm Certification No: ____________________________
No EPA Lead-Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued
(Section 3097, Civil Code).
Yes No
Lender’s Name: ________________________________
Lender’s Address: _______________________________
APPLICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgements, 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 ______________________________
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE,
OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.
10367 MENHART LN 375 15 044 BLD-2022-1093
NORCAL HOME SYSTEMS INC
2022-08-03 Jasmine Archbold 35000
NORCAL HOME SYSTEMS INC 1041729 07/31/2024
Josip Lukin
4
4
4
4
Aug 3, 2022
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
C LUPEERTINIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • uildin cuoertino ora
PERMIT CANNOT BE FINALED UNTIL, THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNEi2, AND RETURNED,TO THE BUILDING DIVISION ;
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2019 CRC Section R314, R315, 2016 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, R315, and CBC Sections 907.2.11.5 and 420.5 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) - (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
I 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 specified below have been tested and are operational, as of the
date signed below. _ I -;� )
Address:
Permit No.tL ,- Wz- (® q
Specify Number of Alarms: # Smoke Alarms: =# Carbon Monoxide Detectors:
t have read and agree to complV with the terms and conditions of this statement o be signed by owner or contractor below
Owner (or Owner Agent's) Name:
uMw4zw, Signature....... ...........................
....... Datepp. z.
Contractor Name:
t✓ Signature re...................ic#0..........Date:g..!�
Smoke and CO jorm.doc revised 0711217021
INSPECTION RECORD
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10367 MENHART LN Cupertino APN: 375 15 044 PERMIT NO: BLD-2022-1093
OWNER'S NAME: MAHESHWARI KRISHNA AND ANNU OWNER'S PHONE: Not Provided
CONTRACTOR: NORCAL HOME SYSTEMS INC, 4085 NELSON AVENUE STE 1 CONCORD CONTRACTOR PHONE:
DATE ISSUED 8/22/2022 12:52:51 PM ISSUED BY:VALUATION: $35000
JOB DESCRIPTION
(N) 20-PANEL ROOF MOUNTED PV SYSTEM (8.00KW) REV#1 - RELOCATE ARRAY-
INSPECTION TYPE DATE STATUS INSPECTOR
FINAL BUILDING 2022-08-04 Failed James Lee
FINAL BUILDING 2022-08-22 Passed James Lee
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 12 MONTHS AFTER ITS ISSUANCE, OR IF THE WORK
AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12 MONTHS AFTER THE TIME THE WORK IS COMMENCED.