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Permit Information
Permit Number'
09040069
t't
Status `
v
Master Number
Project
�—
Apply Date `
04/13/2009
Permit Issue Date
04/30/2009
Certificate Issued
06/02/2009
Certificate Type
Certificate Number
j
Permit " Property 1J Zoning 11 Applicant
Permit Details
Permit Type' ISOLAR-RES
Notes 2
Operator patg`
Operator patg
Operator 'PALM
Contractor " Defined Fields
Locatinn Information --
Address 10183 COLBY AVE
City/State/Zip CUPERTINO
APN 31628043.00
U nit
01NI-ler Entity Inlormation
Owner Name x MARTIN LLOYD H AND JULIE B j
Use Default
Address Home 10183 COLBY - J
CA 95014
CitylState2ip CUPERTINO CA _ _ - — — 95014 2419
RESIDENTIAL SOLAR PANEL
Usage Class `
N/A
NON APPLICABLE T�
Applied Value x
386731
SQUARE FT.
Oj
Calculated Value
ON
US C-404 Type
434
ALT: RESIDENTIAL
Permit Form '
AUTOPERM - PERMIT'
Ownership
1 Private
Project Size
EXPRESS -EXPRESS
Inter permit status
Purpose/Special Conditions - -- -- —
(INSTALL ROOF MOUNTED PHOTOVOLTAIC SYS (NO BATTERY
BACKUP)
FILMED— 2011
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Fees
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Inspections
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(fti Holds
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lQ Close Permit
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
M b f
BUILDING ADDRESS:
PERMrr NO.
10183 COLBY AVE
COBALT POWER SYSTEMS, INC
OWNER'S NAME:
FERMPr ISSUE DATE
PHO
A CONTROL NO.
(650) 938-9574
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o a o a
LICENSED CONTRACTORS DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
;n cull forsand eff
—�
INSTALL ROOF MOUNTED PHOTOVOLTAIC SYS (NO BATTERY
License Class Lie. � � N t ��
Date Contractor
BACKUP)
ARCHrrE= DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby alarm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031-5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
"
prior to is issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) or Division 3 of the Business and Professions Codc) or
that he la exempt therefrom and the basis for the alleged exemption. My violation of
3 8673
APN Number
Occupancy Type
p y 1J p
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (S50o).
31628043 .00
❑ L as owner of the property, or my employees with wages as their sole compensation.
'
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec.7044, Business
and Profession& Code. The Contractor's License Law does not apply to an owner of
property who build& or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. if,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property. am exclusively eomrsaning with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li -
=rise Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, 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 Workrefs Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation I summ" a/1r�i�eyLand Policy number aer� I
(] �1
Cartier. o�lea I Yit roliry No.: V
CERTIFICATE OF EXEM ON FROM W RKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or Icss)
1 cenify 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 Workers' Compensation
Laws of California. Dale
Applicant
NOMCE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONMUCnON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
-
Lender's Name
,
Lander's Address
I certify that I have read this application and state that the above information is
'
cored. 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
shove -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
which may in any way accrue against said City
andexpensesthis
itla,judgm f the
in ce of the granting of this permit.
in c�ICIM
APUNDE NDS AND WILL COMPLY WITH A L NON -POINT
/ D
Issued by: DateCE
REGU
Re -roofs
--
Type of Roof
ignature of p V onlramr Date
ZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as delined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
All roofs shall be inspected prior to any roofing mate 'al being installed.
❑Yes 9<1)
If a roof is installed without first obtainin inspecto I agree to re
Will the applicant or suture building occupant use equipment or devices which
emit hazardous air contaminants as dcfi by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes u
1 have read the hazardous materials requimmems under Chapter 6.95 of the Califor-
nia Health & Safety Code; Sections 505, 25533 and 25534,1 understand that if the building
does not c rremiy have a tenon t it is my responsibility to noti the occupant of the
requ; ntswhich rmIssuancc0acenirrca oAq
Signature of Applicant Date
All roof coverings to be Class '%" or better
'ztd Date '
Ownsor autbq Ant
CITY OF CUPERTINO
SOLAR PANEL
PERAHT APPLICATION FORM
ojoy oo��
APN # 12 1 �O 00
Date: PO C, 13 (Z0 l
Building Address: ►� 3 CGuey nvt
Owner's Name:
Phone #:
Ivue rn)Wr►n
Comic,- 53N-Co062z
Contractor: Phone #: 6so - q z,S _ cl S-7 9
Contractor License #:
Cobs It Poser
Fax #: UR) - 9 3$- 95 -73
�S 20 (o -%
Contact: Phone #:6S0 --7 H _ 315 O
Cupertino Business License #:
mafk Fax#: bso-ff3S-9G-73
2&0-71
Number of Panels/Units: -2-7 Kilowatts (Commercial Only):
Job Description: l a Sa W 1 CIA vL
-e r y Zack L)�
Residential Commercial ❑ Valuation (cost of project
Green Points:
,•.,/
1.2 KW — 6 Points ❑ 2.4 KW'— 12 Points ❑ 3.6 KW —18 Points u
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1.SOLARPANL
Commercial Solar Panel
E
SOLAR-COMM
1PHOTOVCOM
Photovoltaic System
Commercial
E
1BSEISMICO
Seismic Commercial
E
1ELCPLNCK
Plan Check Fee
E
1 SOLARRES
Residential Solar Panel
E
SOLAR-RES
1PHOTOVRES
Photovoltaic System
Residential
E
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B