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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18731 TILSON AVE CONTRACTOR:COBALT POWER PERMIT NO: 10030003
SYSTEMS,INC
OWNER'S NAME: PHILIP&NANCY BOYLE 885 MAUDE AVE DATE ISSUED:03/10/2010
OWNER'S PHONE: 4087421580 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)938-9574
LICENSED CONTRACTOR'S DECLARATION7
Q�/'�I,, BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic.# U/OOPI r— 7
ContractorMECH RESIDENTIAL COMMERCIAL
�(��Gy��� � ��ate t5 �
I JOB DESCRIPTION:INSTALL ROOF MOUNTED PHOTOVOLTAIC SYSTEM
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions WINO
Code and that my license is in full force and effect. BATTERY BACK-UP 24#PANELS/UNITS
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$33316
permit is issued.
APPLICANT CERTIFICATION APN Number:37518049.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all no - oint source re lations per the Cupertino Municipal Code,Section
9.18.
Signature Date �f�fd!!!! Issued by:� ��� Date:
❑ ER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the,
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued, contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code ections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Ow er or a t ori gent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:3 J
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this e t.Addition y,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non- oint urce regul ns per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature s Date (6 0 Licensed Professional
r
CITY OF CUPERTINO
SOLAR PANEL
PERMIT APPLICATION FORM
CUPER 04
APN# .-7 i Ro Lf 9 v Date: ' l
Building Address: I
113 A .
Owner's Name: P o e#
NAS g611,1G44
Contractor: Phone#:(�S7}Gj3�'�S7 Contractor License#:
UJ Fax#: - (Q
Contact: Phone#:(fiT-—ILA'81S0 Cupertino Business License#:
" \V,6* Fax#:
Job Description:
J,AS1^�- qCD-f-
w k3o �J
Residential Commercial ❑ Number of Panels/Units: Kilowatts:
Valuation(cost of project 1j�ip
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Points:
1.2 KW—6 Points 2.4 KW— 12 Points ❑ 3.6 KW— 18 Points
Quantity Fee ID Fee Description Fee Permit Type
Group
1 SOLARPANL Commercial Solar Panel E SOLAR-COMM
1PHOTOVCOM Photovoltaic System E
Commercial/Multi-family
1BSEISMICO Seismic Commercial E
IELCPLNCK Plan Check Fee E
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee COMM & RESID
l SOLARRES Residential Solar Panel E SOLAR-RES
Revised 08/20/2009
G Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: yh, 4 PHONE #
GENERAL CONTRACTOR: SXjj FAX #
I am not using any subcontractor 1 3 1L-9-010
A.
1 ature bat6
Please check applicable subcontractors d p&mlete the following information:
SUBCONTRACTOR MUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date