08090189 CTTY OF CUPERTINOx� Fa.��.t""
BUILDING DIVISION PERMIT s CONTRAGTOR I�NF�(1 MATIQ„N, `.
BUILDING ADDRESS: PERMIT NO.
10460 MADERA DR COBALT POWER SYSTEMS, INC 08090189
NEWS NAME: PERMIT ISSUE DATE
HAYES RICHARD J AND NANNETTE 2444 OLD MIDDLEFIELD WAY 10/07/2008
PHONE: cmo c SANITARY NO. CONTROL NO.
(650) 938-9574
ARCNTTECl/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u O o LICENSED CON RACIOR'S DECLARATION
1 hereby affirm Wt 1 am Iumnted under provisions or Chapter 9(commencing Job Description
_ with Sccti=]o(IU)afDiviilon3of deOwnev and Profrseimu pCode,and myliccnscu IINSTL RF MTD PHTOVLTAIC SYS(NO BATTRY BACKUP)
n sm full forte and eR o b9
Mans �..
ppp Dak 1 , Contfano
q
ARCHITECTS
DEC ATI N
2 1 undemand my Plans shall be used as public record
9't; canted Profewow
v, OWNER-BUILDER nn to,C DECLARATION
I hereby x(E=that I I.S.eumpt from Ne fes eues Co License taw for use
O O following tinea.(Saito]ID LBusiness and Prove time Code:Any city or county
$ which mm in a permit re cores the alum improve,demolish,m c a sig soy suumum
_i priorbisceensed Moment
requires the for s=hperu,'$ ices Law moment
ss< Nan Meuliaroed puswant bNc povivisiuo the oftheBrnn= nianmlaw(Oupter9 Sq.FL Floor Area $33817 Valuation
x l•R (eons a is ext with hendion 900d the
Division r he ai Business sod on.Any
Cade)of 3 3 817
— that io ts 31.5 b any applicator
li and the Ensu for he alleged eumant to Any vioution of
Section tion five
airy red done ren a permit subjects the applicant to a civil Penalty of Number Occupancy Type
=t more than Rwe hutdmd aollan(gw0). � 32635048 ��
wi Las9w=rk.Irep strectmmY.t Wena with wgn ssNee sk tmt.Bundram
will Pr lesion"Clamand The Com isnot Nunensedicil La doesad old apply 7DN,B mer of Required Inspections
and my.1m,bu Calc The Canmcenes License law uch or appy en rt owner of q .
ows cr ywha build vi impmw Neimpr and who dmastcE work himselfof Wough his
two empbym,prong or i pnevemausamb improvements,wit in not ear ormmortared fm we r,
Wilderhowever.it Avedng hu i ee o femw u sold within ort year of I m rove far the ow=e-
. .it). will Nve Ne burdw of proving that k did=n build m Improve far purpose:or
sale.).
❑1.as Motor of the property sen exclwvdi,contracting with licensed a=smuts It
=mtmet the project(Sec.I .Business and Pmkseiosu Cade)The Contravenes V-
cwe law dens out appy in an owner of property who build or impmw%thes=n,and
who contracts for such Projects with a anuanor(s)licensed pufamnt en the Ca Assure ra
License law.
Q lamsocmpsuMersec. ,B&PCrmthistes=n
Das
40- WORKERS COMPENSATION DECLARATION _
1 hereby gin=under penalty,of perjury one of the following declandom:
❑1 hs.c aM will milnuin•Certifiauar Convent en calf-insure fm Wmtrls Compcn-
safion.as ptrivide i for by Section 3700 N dm labor code.for the performance of the
went fm which this permit k issued.
❑I have and will maintain Workers Compensation Imtusnce,as,tea mrod by Section
3700of the tabor Code.for the performance of Ne weak for which this permit is issued. '
My Werters Compensation Insurancecarrier and Policy number art:
Cartier: &J-eC'e-O\ontlla f( policy,No.T711 00057-Cff
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This account reed=the completed Ifft permit is fmerm hundteddonata(SIM)
alms)
1 oerdf-v deal in dm performance of the work for which this Permit is used.l sMll not
employ any person in soy matters era become subject in the Wo lays'Compensation .
Laws of California.Dau
A,U.t
NOTICE TO APPLICANT:IL after making this Cenifiau of Eumpouan.you shaub
become subject in the Wolters Compensation provision of the Tabor Code,you most
O foMwiN comply with such provuiom or Nu permit shall be deemed revoked.
z'71 CONSTRUCTION LENDING AGENCY
[-+ I hereby Aftrm the Neu uacowscuon lending agency,for Ne pMormeoa of
C> Ne weak for which this Permit u issued(See.3097,Ci,C)
Lp7 Q tender's Name
z fenders Addmat
U O 1 anify that I have tad this application orb sou the ft oboe information is
11, T-' conmy 1 agnea in comply with ill city and cowry ordinances and sus urs muting an
O Wilding construction,and hereby auNofiu representatives of Nu city encrser upon the
r shove-mentiomA property for inspection purposes
F 6, (We)agree to can.indemnify and loop harmless the City of Cupertino against
ti VI liabilities,Judgments,costs W experua which may in any way secret age=led City
U z son cmm,.APPLICANT
of the graining of Nu D WILL
/� L-f�
^Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R U TIONS. / `/ -
tD � `� Re-roofs
Signs=of Applicant/Contractor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building occuputsen.or handle haotdom material
deR=d by the Cupertino Municipal Code.Chapter 9,11,alb the Hnith and Safely
W.Section 25531(x)7
❑Ya I�Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha ummus air conumimnts as defined by du Bay Area Air Quality Management all new materials for inspection.
Merely
❑Yes P(No
I Mw mad NehasardouamauMils mqukcmensunder Chapur6.95 orNe Califon.
nuHalth&Safmy Codc.Secvions 15505,25533 an125534.I undrmand thniftie bwhf cit
dem=t currently have a tenant.that it is my responsibility m notify dtc mcupans of the
not; aU. .chmuabcmetpd uiuvanceoraCcrdRauofOc=p=q/. Signature of Applicant Date
Oo�C/ravAAgmi.dag,., I�o,t All roof coverings to be Class'W'or better
C