06050248 CITY OF CUPERTINO
BUILDING DIVISION PENT aCONTRACTOI2INFORMATIOIV �
BUILDING ADDRESS: PERMIT NO.
COBALT POWER SYSTEMS INC 06050248
0 E: PERMITL4UEDATE
SANITARY N L NO.
ARCHITECTIENGINEER: (6519)948-95 �4 BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
jp LICENSED CONTRACTOR'S DECLARATION Job Description
u C 1 hereby afErm that I am I'i¢Medi under provisions of Chapter 9(commencing
wits Sec11on 701 of DiAmon 3 of the Business and Professions Code.and my license is
i N in full forte and.frees
. " j/), INSTALL ROOF MOUNTED PHOTOVOLTAIO SYSTEM (NO BA
cxr7ECTSDECLlicrec I UP BATTERIES) �� �
I undersand my plans shall bu used u public nem B U
U
< Liccrucd Pmfcssional
^� OWNER-BUILI)ER DECLARATION
1 hereby aflum that I am exempt from the Contractors License Law for the ry
50 following reason.(Section 703 1.5,Business and Professions Cade:Any city or county II 7AI ')MOL`
$IAL which require a permit In cnnsuutt alter,improve,demolish.or repair any structure L Il
prior N its issuance.aim mquiTa the applicant for such permit to rile a Signed moment
c� that he u licensed puu
rnnt to the provisions of gas Contractor's Liana Law(Chaper 9 Sq.FL Floor Area Valuation 193
(commencing with Section 7000)of Division 3 of Ne Business and Professions Cods)or
t$ that he is exempt Nemfrom and the buss for the alleged ca mption My violation of
Semon 7031.5 by any applicant for a permit subjects the applicant N•civil penalty of APN Number
not mare Nan five hundred dollar(S500). Yana `J P
❑1.u owoer of de propety,a my wployee wits singes u mhe'v sole compensdmn, 1754�)049 On Tel
wiR do Ne wort and Ne swctua Is not amended or offered fwsale(See.7044,Business
gul Pmfessious Caec Tie Con racmra Liccrue Law doe but appy m an owner or Required Inspections
property w h.bui Ids w improve thecor,end who docs such work himaelr w through his
own employees.provided that such improvements are notinend, wofferedforme.IL
however.Ne building w improvemml 4 sold within arc Sear of compktioo.the M -
builder will hale Ne burden of proving that W did wl Wild or improve for purpose of
ask.I.
❑1.as Momma of the propcny am aclusiwly contracting with licensed contraears in
construct the project(Sec.70",Business and Profession Code:)The Contractor's U.
come Law does not apply to an Manor of property who builds or improves thereon,and
who contracts;for Such pmjc=with a contractops)Remand pursuant in the Comancloft
Limms Taw.
I not acmpt un4r Sco. ,B&P C for Nis reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,rare of the following deelarulonv
ve and will maintain aCuli6ae of Consent o self-insum for Workeh ComiNn.
sation,as provided foe by Section 3700 of the Labor Code,for the perform.of the -
work foe which this pormit is issued.
XIve haand will maimain Workeru's Compensation Insurance• m4uimd by Section
] of the Labor Code,fw Lha performance of the wort for which this pctmit is issad.
My Worket'a C mpeus Iusunna ani and Policy_numbeart:
Carrier Policy No.:
C�MON FROM W RKERS'
COMPENSATION INSURANCE
CITU radon need not he completed Rue permit is future hundred dollars(SIM)
or less)
I anify Nal in the performance of mW wart for which this permit is issued.l shall nos
employ any person in any reamers at to become subject to th,Workers Compensation
Laws of Caliramia.Date
Applicant
NOTICE TO APPLICANT.IL after making this CaniBete of Exemption,you should
income subject m Ne Worker's Com tiougon promious of the Lahor Code,you must
Orordowi h comply with such provisions or this permit shall be deemed evoked.
rrj CONSTRUCTION LENDING AGENCY
1 berchy.M.than there I,.consu osibm lending agency for the perfurmma of
..m
the wart for which IMS Perris Is issued(Ser.3097.Civ.C.)
Q LandeYt Name
Z Lendees Address
m 0 1 certify that I hale tad this application aha sue this Ne neve information u
m E" mI1Cct.I agree to comply with all city and county ordinances and some laws missing to
m V building construction.and hereby outhouse repraenutivus of this city in crew upon the
m L7a abuvo-menuoncd property for a penes purposes
m W (We)agree to save,indemnify and kap harnlas the City of Cupertino against
i,imZ in consequence
of thisuswhich may In my way acmuc gainstseid City
1'•Z, in eonsegwna of mW granting of Nu permit. s
APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by:S4�4 Date
SOU CE Bou TA NS.
��' / w'/ _ _P14 Re-roofs
Sgnatumor Appliam/Con ter Date
HAZA %S)ATERIALS DISCLOSURE Type of Roof
Will de applies.,or forum Wilding occupant corm aro handle haurdous material
as defined by IW Cupertino Municipal Code.Chapter 9.12,and the Halts and Safely
Code.Section 25532(a)?
OYa o
All roofs shall be inspected prior to any roofing material being installed.
OtII^'
Will Ne applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I ,huraNnus air contaminants u defied by Nc Bay Arse Air Quality Management all new materials for inspection.
I District?
0Ycs ❑No
I have mad the huallous materials requimments under Chaper6.95 of the Califor.
oil Health&Safety Cock.Sectors 25505,25533 and 25534.1 understand mheifu c building
does not currently ham a tenant,that it a my respomib lity m notify the occupant of the
requirements which msec me pct ,n ismarce or rureate of Occopen Signature of Applicant Date
S ��
Oer of authomcd gcnt Daug
All roof coverings to be Class "B"or better
e '