05100186 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO r 12A�TORINP'C}
r2 r. - ... u..e,5,st'.'
eulwlNC ADDRESS: COBALT POWER SYSTEMS, INC PBRMRN0.05100186
p OWNER'S NAME: PERMIT ISSUE DATE
LYNN YOUNGS 770 LINDEN
L SANITARY NO. CONTROL NO.
650) 948-9574
ARCHITECUENGINEER: BUILDING PERMIT DlFO
BLDG ELECT PLUMS NECH
O LICENSED CONTRACTORS DECLARATION lob Descrl tion
t 1 heroby alnnn that 1 sm licenced under pro hiow of Chapter 9(mmmmedal p
with Sation 70011)ofDivWon 3 oflhe Business W Profesuow Code,aed my(cease h
+� infalifarceand fpm) INSTALL PHOTOVOTAIC. SYSTEM, ROOF MOUNTED
; - exec mCws O Lm.g
II-- Dem Contractor NO BATTERY BACKUP
ep ARCHITECTS DECLARA i i
t I undersd my plans W used u public rocor
tan
kled Licensed Profas knal
y OWNER-BUILDERm the ConT70N
a 9 1 main elnm on 11. wmpl from Na Cmians Co License Lew for the
O o fallowing meson. aroult t Rn tale Business and Proimprove.
dem ns Cad,:Any city or county
3 which npulme s p wo 70 construct,mime,improve,de ermit.or saPnit my muctumd statement
"hprioe is mmert parste ilIn the Omepionao for each Cocura toe mNeeeLaw(Cammem
< dtetbuhcuilwdpnmton7000)ofDivsNoflMCowsoessandettselaw(sCode)9 Sq.FL Floor Area Valu gf6022
Sg�E (cammemingwWgaevera and
dson Division of the Butlnevandon.Myavilaaom Or
that io ts exempt(any cop li end the rem for bj cis the ,•^ant w Ane l pennon a(
Section than by cry applmantfor a s($503mit subjects the appltemlmluvil penalty of AFNNumber Occupancy Type
sot seam than nes hundred dollars(f300). 35601032 . 00
0 I,u owner of Ilia pmpmy.m my wploym with wgesu Ihek sou cwpmuadon,
will do the work.and the museum h ml intended ana@red fnssam(Sec.7044.Business
and Professions Cade The Commutes Liceaw Lew Was not apply W an ower of _ Required Inspections
property who builds or imptuv:a der)an,and who dues such work himself or through his
awn employees,provided deaswh impmwmenu em Out Intended manerW fmsele H.
ha nowr,Ne building or improvement is sold within ow year of cempledon,the Omar- !
builder will have tise burden of proving Wt he did not balld or Improve fan purpose of
sale.).
0 1.u Owner of Ibu property.wo exclusively eomnming rith 0.+•.-e cenuuaon to
eawauct die pmjem(Sec.7044.Business seed Psofemors Cade:)The Commences U.
ceeae taw Was not Imply In m owner of pmpenywho builds or Improves tierton,and,
who commis for such proketa with a con mmer(a)licensed pursuant to the Contractor's
License Law.
0 lameaemplundm See ,BQPCfm Nhnvmn
Dam
4 WORKER'S COMPENSATION DECLARATION
I hereby Antw under penalty of perjury ave of the following declandom
I haw end will maintain aCm0f1am of Comm(to self-iwuw fm WmIm`1Campers-
sadon,u provided fm by Seems 3700 of the tabor Cade.fw the performwtce of Ilte
wank for which this permit is issued.
1 bens and will maintain Workees Compensation Insurance.sa acquired by Secdon
W of the labor Cade,fan the performance of the work for which this permit is heated.
My WarkeesC semen donlwtencees ' and Polity number art:
Came-`��Le� PON G �7�i Ofll..l
CE Fl TE ENS MONMGMWORKERS'
COMPENSATION INSURANCE
(Thin section need set N completed Lido permit Is forane hundred Wflan($100)
m mu)
I cerdfv ft in the performance of 006 work for which this permit h wue0.1 shall tut
employ any person in my waorerso as an became subject a the Worked Campensatim
4w of Ctlifamia Dam
Applicant
NOTICE TO APPLICANT:If.Met making this Ccninnm of Exemption,you shauld
bucome subject 70 the Wo luo's Compensation proAsims of W Labor Cade.YOU mwt
Oforthwith comply with such provWom or this M mil shall be dimmed rtvek,d.
z� CONSTRUCTION LENDING AGENCY
E. 1 hereby straw Nu Nem h•cawtmcdw lending agency far the perfa mem tar
fYi> the work fm which thts permit m issued(Sm.3097,Civ.C.)
GELandees Nemo
=z Lendeds AInle
U0 1 comfy that I hew teed this application and rem the Ilse Waw information h
IL.^ coned.i agree m comply With all City and county aNinswm atM stem lawsrtlWng be
0 rV' building construction.and hereby mNods<rtpmxnudws ofthh city m enterupon Ne
w above-mentiawd property for inspection purposes.
LL (We)agme to an.indemnify and keep harmless the City of Cupertino against
i..t IA liabilities,judgments.caw and expenses which may In my soy acerae egalwt said City h
U Z in consequence of the granting of this Permit. V
APPLICANT UNDERSTANDS AND WIL OMPLY WITH ALL NON-POINT Issued by: Date
SOPMREGULSnONS. -O
//lA/l>1/�/✓� ZIA
Re-roofs
Sigbadere ofApplicarralContalectur Dmm
HAZADOUS DISCLOSURE Type of Roof
Will Ne applicant m future wild's oceupmt slue orhandic haamaw mammal
defend by the CupeNro Municipal Code,Chapter 9.13.and tie Health and Safety
IM�?,Sewan us3:(e)7 �/ All roofs shall be inspected prior to any roofing material being installed.
Oyes $INe
f
Will the applicant or Itauw handing Occupant we wulpmmt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it huamow air commainmw u defused by tho Bay Asea Air Qu dity Management all new materials for inspection.
❑Yes go1 haw mad the hauNnus materials mquirommts undcrCMpmrd.93 oftheCaliror•
Hmhh&SLfctyCode,S=aom 27505.25533 wW25534.I understand thcifde building
s rmt currently hew a cars.Net It h my responslNlily m redly tie occupant or deulmmcnuwhkhm be tpdaemiuuwl oraccmirw oracupwcy Signature of Applicant Date
L0.)Tar aNOd><deg)m �j �� All roof coverings to be Class"B"or better