06090062 CITY OF CUPERTINO
BUu-mnc mvlsloN PERMITOIv +�C7 Xl ,'' Re�T1( 1 ,
BUILDING ADDRESS: COBALT POWER SYSTEMS, INC PERMIT NO.06090062
21845 HERMOSA AV
R'S NAME: PERMIT ISSUE DATE
SHOW WAY YEH 770 LINDEN AVE. 6
t NE: SANITARY NO. CONTROL NO.
(650) 948-9574
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MECH
O
O0 LICENSED CONTRACTOR'S DECLARATION Job Description
1�+ 1 hereby affirm Unit I am licensed under previsions of Chapter 9(commencing P
IN W
Section 70010 ofDlvon 3 ofthe Business and Professions Cmam u
de. my fit=
� y inn full roma and effmt. - SOLAR- INSTALL NEW ROOF MOUNTED PHOTO VOLTAIC
;qz LWnm - Lk.g SYSTEM
CHITR7S DIcLXR /
qqq Dam Can= j(��/}
'
i2< (understand my plans shall he used u public Z'dis✓ ✓
id
' Licensed Professional
:y OWNER-BUILDER DECLARATION
)<E I hereby affirm that 18M exempt from the Contractor's License Law far Ne
:00 fallowing mason.(Scetim 7131.5,Business and fiumadons Cale:Any city or county
j9 V which mquims a permit to consumer.altar.Imi mw:,demo)W,or mpdr any Rrmmm
-Zi prior n its issumec.Ms.requires theappliam for such Permit m rile a signed innocent
l4GNaz he is licensed pursuant to the provisions or six Contractor's License Law(Chapter 9 Sq,Ft. Floor Area Valuzi
(commencing with Sectian 7000)or Divulon 3 of the Busincuand Professions Crum)Or
$
that M is exempt therefrom and the basis far Me alleged esempdon.Any violation of
Section 70313 by arty applicant for,it Permit subjects the appltaat n a civil penalty of t pN Number Occupancy Type
oat ream man raw hundred dollars($50% 3 5 716130 . 00
❑I.a owner of the property,or my employces with Wages as their sole compensation,
win do the work and the structure u not imended m offered for We(Sm.70N,Business Required Inspections
and Professions Cade The Committees License law dors nal apply m an awoor Of q P
property who builds orimprot rash befu,andwho am Out intended
himsel(od far W his
ownewc,the building
pi suchimprosemenlaauintintendedmoBered nor ask,If.
however.NebuildingorImprovementissold edid Out
yeaso(aiamicfrthe Owner.
sak.). will have the barmen of proving that he did rot helm m improve for purpose of
mm.l.
❑1.as Must of time property.am exclusively mnuudng with licensed mntr4nnts to �O
consumer me project(Sec.7014,Business and Professions Cade:)The Cenmcmis LI-
who Law dosnot chPr on eon ownsarproperty who WiWriimpmw Cemmitred,
who Lace for such prokcu with a eonv4cmrt0licensed pursmnt nthe Committees /
License law. O
❑Iota esempl undo See .B&PC far this mason /
Dam �O
WORKER'S COMPENSATION DECLARATION
I hereby efRrm under pe Wty of p Bury one sir the foimwing declamdom:
❑1 have and will mainuia•Can ftam of Comem luself-Ware far Workees Compere
titian,as provided for by Section 3700 of the labor Code,for the performance of Na
work for which this permit is issued.
1 hale arm will maintainW inner Compensation Insurance,as required by Section3 of the labor Code,per this per(armmm.of me wok for which this Permit Is Issued.
My Wars<es ompensation Insurance esmer and Policy number sir:
Policy No.:
ERTIFI TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If site Pettit is future hundred dinar($1011)
or leu)
1 certify mot in me performance of the work fm which this Permit Is Issued,l shall not
employ any Person in any manner an u in become subject m the Woken'CampentWon '
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:1(.after making this CeNfiam of Exemption.you mould
become subject in the Wohoes Compensation provisions of the Labor Code.you must
O forthwith Comply with such Provisions a mu Permit Nm
all be deemed mked.
'Z y CONSTRUCTION LENDING AGENCY
[-s I botchy IMM WL Orem Is a construction lending agency for the Performance of
> the work for which this permit Is issued(Sec.3097,Civ,C.)
U] Q lender's Name
.tea. 0 Lcidet's Address
U 0 1 comfy that 1 have-read this application and sum mu the above information is
lI. F correct.I agree in comply with all city and county ordinances and state laws misting to
DU building construction,and hereby autharire mpresemniva of this city to enter upon me
0. above-memiuncd property,for inspection purposes.
(We)agree m sane,indemnify and seep harmless tite City of Curidino against
F'fA
liabilities.judgments.costs and expenses which may In any Way seem against said City
UZ in consequence of the granting of this permit.
APPLICANT UNDERSfAN1�S AND ILL COMPLY WITH ALL NON-POINT Issued by:S Date
SOURC REG TIONS. ^ `
v Re-roofs
After.o pll on r Dem
H US MATERIALS DISCLOSURE Type of Roof
Will the plicanl in future building mcupanutore or handle haardam material
defined by the Cupertino Municipal Cade.Chapter 9.12.and the Health end Safety
Sidon 3553x4)7 ``�� All roofs shall be inspected prior to any roofing material being installed.
❑Yes l .
Will the applicant or future building occupant um equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hwamous air contaminants u defined by the Bay Area Air Quality MIMARM401 all new materials for Inspection.
District? X.❑Yea goo
1 have mad the hassiduus materials mquimmenu under Chapter 6.95 afore Cabins
.is Health&Safety Cade,Sections 25505,25533 and 25534.1 undormnd thin ifde bdsting
does not..nlly hale 4 mmol mat it is my mmer,lbility m notify me can.,a(M.
rcyuirt nuwhkhm hemPiar
en of C.mrmayr ami. Signature of Applicant Date
Owner or autharixed a lot, Dam All roof coverings to be Class"B" or better