07080252 CITY OF CUPERTINO ` ' ` ' 7 � ` `
BUILDING DIVISION PERMIT ���� 4 ���� ����������`�
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BUILD D RESS: PERMITNO.
'/���� DUMAS DR COBALT °OWER SYSTEMS, INC 07080252 .
OW NER'S NAME: PERMIT LSSUE DATE
ALBERT LIU 770 LINDEN AVE 10/04 2007
JNE: SANITARY NO. CONTROL NO.
(650)946-9574
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
� � � �
i p p LICENSED CONTRACTOR'S DECLARATION JOU DeSCrlptlOil
� v� 1 hcrcby aCGrm that I am liccnscd uncicr provisions of Chapicr 9(commencing
;Z� wiihScciion70cx))ofDivision3ofthcBusinessand ofcssiansCodc,andmyiiccnscis INSTALL ROOF MOUNTED PHOTOVOLTAIC SOLAR SYSTEM
>> y in full Corce and ef(ec�
� v� z Licensc Ciass L�. #
: �, �p Datc �_�_ Conuacwr
�� HI't'ECI'S DEC
i a a I understand my plans shall Ac used as pubiic reconi
)4U
' u. E' Liccnscd Pcufcssional
� y � OWNER-BUILDER DECLARATION
I hcrcby alTirm thal 1 am cxcmpt C�um thc Cantractor's Liccnsc Law !ar �t�c
� p o [ollowing rcason. (Scction 7031.5. Busincss and Profcssions Cafc: Any city or coun�y
�,°, �i which rcquires a pertnit to conswc4 a���. �mpmvc, dcmalish, or repair any stcucture
° Z� prior ui i�s issuancc. also mquires t6c applicant for such pertnit io G� a signcd sutcmen�
-< that hc is liccnscd pursuant to thc provisions of thc Comracmr's Li�rnse [aw (Chaptcr 9 )C�. Ft. FIOOt AieS Valuation
t t �(commencing with Scction 7000) of Division 3 of thc Busincss and Profcssions Codc) or $17 4 4 8
i 3� ihat he is exempt Nccefrom and Ihe basis Cor the allegcd exempdon. Any violuion o[
Secrion 703I.5 by arry applicant for a pertnit subjecu the applicant w a civil pcnalty of [� Number Oeeupaney Type
not more than Cw hundred doUars (5500). 3 r J 9 2 6 � 0 3. V�
❑[, as owncr o[ tt�e property. a my cmployces with wages u their solc compensation,
will do the work. and �he st[ucture is not intended or ollered for salc (Sec. 7044. Busiuss Re uired Ins ections
and Profasions Code: 'Rx Contractor's License Law doc4 nat apply W an owner of Q p
property who builds or improves thueon, and who does such work himsel[or Nrough his
own employccs. providcd that such improv�ements are not imended or ofteced for sala It.
hawever, the building or improvement is sold wi�hin one yesr of completion, thc owner-
buildec will have the burden of proving that he did not build or improvc for purpox of
sa�.).
� I, as aw�r of the property, am exclusively contracting wiW liansed conuxtnrs a
construct the projen (Sec. 7044. Business aad ProCessions CodeJ The Contractors U-
ccnse Caw does not apply �o an owncr of propeny who builds or impcoves Ihe�eon, and .
who conuacts (or such projects with a contrxtor(s) licensed pursuant w �he Conuactors
License Law.
❑ I am ezempt under Sec. . B& P C fw this reatoa
Owner Date _ .. _ _
WORKER'S COMPENSAT[ON DECLARAT[ON
I hereby a[fitm under pcnalty of perjury onc of the lollowing decfarations:
� I hsvc and wilt maimain a Certifcatc oCConsent to setf-insure (or Workcls Compen-
satian, u providcd for by Section 3700 aC [he Labor Cade, for �de performarce o[ the
work for which this permit is issued.
❑ I havc and will maintain Workcr's Compensaaon Insunna. as icquired by Scction
3700 of the Labor Cade. Cor the perCormance of the wwk for which �his permit is issued.
My Workers Co pen auan I cance c'cr and Poliry number are:
�u; ..,� Policy No.:
TIF[CA7'E OF E CEMPl70N FROM W RP.IItS'
COMPENSAT[ON [NSURANCE
(This scctian need not be completcd if the pccmit is far onc hundred dallars (S I00)
or IcssJ �
I cenify that in thc per[ormance of Wc work [or which �his permit is issucd, 1 shall irot
c�nploy any person in any manner so as to become wbject to the Workers' Compensatian
Laws of Califomia. Da�c
Applicant
NOTICE TO APPLICAM: If, af�cr making �his CcrtiGca�c ot Excmpuon, you shouW
become subjcct to thc Wortcr's Campcnsation provisions of Nc Labor Codc, you must
� O forthwith comply with such provisions or this pecmi� shall bc dccmcd revokcd.
z ""' CONSfRUCC10N LENDING AGENCY
(- � I hereby allirm U�at thece is a conswction lending agency Cor the perfortnar�ce uf _
(.Y, � thc wurk Cur which this permit is issued (Scc. 3097. Civ. C.)
w� A L.cndcr's Namc �
a z C,cnder's Address
V � 1 ccnify �hat 1 havc rcad this application and su�c iha� thc a6ovc in[o�matiun is
�� cortect. I agree to comply with alI city and county oreiinances and sute laws relating w
� U building conswction, and hcreby authori�t rcprescntativcs of �hisCiry to cntcr u�n �hc
� W ahovc-mcntiuncd property for inspccuon purFwses.
a (Wc) agree �o save, indcmni(y and kecp harmless thc City o( Cupcnino against
�� Iiabilitiu,judgmcnLS, costs and expcnscs which may in any way accnic againsl said City
(� z in consequence o( thc granting of U�is permi�
*�-� APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date /G� —
SO R REG TIONS. —
' ' Re-roofs
S rc pp o r ��
H ' DOUS MATERIALS DISCLOSURE Type of R oof �
�lt applicant or fucurc building occupant storc or handk harardous mucrial
as dcfincd by thc Cupenino Municipal Codc. Chaptcr 9.12. and thc HcaIW and Saltty
Codc. Sccaon 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑�'� �° ,
Will U�c applicant or fu�ure building occupant ux cyuipment or dcvices which If a roof i; installed without first obtaining an inspection, I agree to remove
cmit harardous air contaminan�s u dcGncd by ihe Bay Area Air QualitY Managcmen� all new m aterials for inspection.
auri�i� P""
p Ycs
1 havc rcad the haiardcws ma�crials rcquiremcn�s umicrChap�cr695 of ihc Cali[w-
nia Hcal�h & Safcry Codc, Sections 25505, 25533 and 25534. I undc�stand thaz it Ux building
docs not curtcntly havc a�nan4 �hat it is my pantibility m naify ihc a:cupani of IAc
rcyuirc cntswhich x���+o� � ac�,;r�a�ora�,P��r. SignatureofApplicant Date
Ow rorauih rizc cm � o„� All roof coverings to be Class ��8�� or better