08050179 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR,ANEORMATION
x 71ha_.k �ilH' kS�
PERMIT No
BUTIS'T�Y AVE COBALT POWER SYSTEMS, INC 08050179
OWNER'S NAME: PERMIT ISSUE DATE
CHRISTOL JAMES T AND ANN E 2444 OLD MIDDLEFIELD WAY 06/10/2008
ONE: mo L' SANITARY NO. CONTROL NO.
(650) 938-9574
ARCHTIER/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACrOR'SDECLARATION lob Description
uwu 1 ion 70 affirm Net 1 am Ifuered Bu under pmviaeu of Code.thiptar 9 my ficenc,is p
ii whuSecrceand0)ofDiviaion3afthcButinessaMProfeuiunCode.andmylleenseu INSNTL ROOF—MNTD PHOVOLTAIC SYS(NO BTTRY BKUP)
n?H in full face and eB O
54i Liuvc--�Lt.i
'-,^p Date Cannula
F 7W7W ARCHll W be thSDFLLARATIO
W V I uMeraanJ my Plana shall .ed u pab4c records -
L Licensed Professional
5 OWNER-BUILDER DECLARATION
as 1 hereby affirm that 1 am exempt from to Contractors License Law for to -
OO following moan.(gentian 7031.5,Busman and PmfeNon Code:Any city or county .
u$( which requires a permit m construct.eller,impmvo,dcmnlbh,.¢pair any awctum
prior In its issuance.also requires the applicant for such permit to file a signed statement
i e lemMisBeenampaawattotoprovlamvorweCamnctirauenmevw(Chapter9 Sq.Ft. F1oorArea Valuation
.� (commencing wit Soction7000)idDivision3oftoBusionaand PmfeassiamCode)or $24883
y $ this le is exempt deamfn.o and the basis for the alleged exemption Any violation of
Section 703M by any applicant for a permit subjeccs the applicant to a civil Penalty of
not mare than E e bananas della¢(SSW). 3 5903 0 0 8 .AW Number Occupancy Type
❑Loilmwa acme to seac,ar 4 nothi indn with wagasudtci(see comperuadon,
and Pr thcwons;and the swcture on wls Lace d a caw red osmole(ply te,a4,Business
pro Professions;Calc The Conlrldom.Licawao Law don cot apply m an owner of Required Inspections
mapenywho builds.ed Oat s th insinower who dasauchwark oroya or Waugh his
awn..fasennpirgori . im issemennare not outdNoroRemd formic.B.
builder,the Wilding.improvementuseldwithinim Weldofmmplcdogduowrcr-
builder will have the burden of poring mat W did cot dtiltl.improve(car puryoz Of
ole.).
❑1,as..of to pmpcny,am aeluawmly cannectini with licensed eontraemn to
construct the project(Sec.7044.Business and Prifecsions Code:)The Contractors U.
cense law does not apply in an owner of paoiony who Wilds or improm thereon and,
who contracts for such pxjeLV wit a ceremonial licensed present in de,Comma ars
Lice nY Law.
❑lamcxamptunderSee ,B&PCf.thisreamn
mer
Data
WORKERS COMPENSATION DECLARATION
1 hemby affum under pnity of perjury arc of the following denlantion:
❑I ham and will maintain a CnadBata of Consent he selRlnaum for Workrfa Conten'
ruin,u provided for by Scotian 3700 of to lab.Code,for the peRarmanm of des
wo,for which this permit is issued.
t]1 have and will maintain Workers Compensation Insurance,as mguired by Section
37W of the lab.Code,far the performance close work for which this permit is bMcd.
My Wurken Cam�`nation from trier and Policy number art: ,�k�'/
Grtm'..Li✓l0A 7r7;;tt/ Paliry Na.:CjdL/Q(/lIY7a�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ildssmdm,sed an,W completed if,W Permit is twang WndreGdoBus(SI W)
or Ieal)
I comfy mot in on prfotmenc,of the work fm which mil Permit is issued.l shall not
employ any person in any mannerso as m become wbj,m in the Werkcn'Compenotion
Laws of Califomis.Data
Applicant
NG17CE TO APPLICANT:If,after making this Ccoifrne of Exemption,you ahauld
become subject be me Warkefs Camraces an PmrlLata of the Lab.Cade.you must
.,O forthwithcomplywit such Provisimu a mu Fenno Kali W dunrd mvmkW.
'z y CONSTRUCTION LENDING AGENCY
m do
t-t I Wmby a1Tut Nene is a construction lending agemy far the performance or
6i- the work for which this Permit b issued(Scow ID ,Co,C.)
4 Q Lender's Name
Z)z Leaden Add.
U Q 1 cenify mat I have mad this•pplintion and sate this the abase informaWn u
Ig.P cgrrecl-I span in comply with all city and county ordinances;and sate laws relating in
-0UWilding consaucdan,and hereby antoo.repoexnudw of this city or anter upnnW
r W aWve-mentioned ptopny,for inspection parpava
(,gy (We)agree to ave,indemnify and keep harmless the City of Cupertino again,
rY y liabilida,judgments,eons and expenses which may in any way scow,agaiat said City
U Z in conxgmm.a of d¢granting of this permit.
APPLICANTIssued by:UNDERS NDS AND WILL COMPLY WITH ALL NON-POINT
so�{RCE f ULA IO S. Date
1^1f 7S ^ s ' In&( ()� Re-roofs
Signuureaf ApphutNCom tar Dale
. HAZARDOUS MATERIALS DISCLOSURE Type of Roof
by
ft Capons.�M-MWlldinge-Chapter
an to and
archly
u dcBSm by the Cupertino Mumcipl Codc.Clupnr 9.13.and Ne Halth and Safeq
.se Y.zss3za)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applicam or future building occupant sax equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air contaminants In de incl by the Bay Area Air Quality Management all new materials for inspection.
Distinct?
❑Yes a
I hast rad the haardouamamriaH mquWmems under Chapxr695 aft i,Calif..
nu HalNh SafetyCode.Secd.u25505.25533 and 25534.1 urnMrsund thatifde Wilding
don cot candy,bas ¢t
e a am,this it u my raponibility m ramify do amop or of ft
mqu'remcnnmtchRwnWiimmu�asae.f.conirtasmor aacy, Signature of Applicant Date
-�S�I�I zx �O�aK
Owncror aumomcd agent D,a All roof coverings to be Class';4a'or better