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B-2017-1495 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1495 10019 OAKLEAF PL CUPERTINO,CA 95014-1127(326 18 057) COBALT POWER SYSTEMS INC MOUNTAIN VIEW,CA 94043 OWNER'S NAME: CHONG FAY JR AND EDITH S TRUSTEE DATE ISSUED:09/08/2017 OWNER'S PHONE:408-313-9026 PHONE NO:(650)938-9574 6. t 6► 1: IC t' I BUILDING PERMIT INFO: License Class C-10 Lic.#820697 Contractor COBALT POWER SYSTEMS INC Date 06/30/2019 X BLDG X ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N)23-PANEL ROOF MOUNTED PV SYSTEM(7.71 KW) I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -INSTALL NEMA OUTLET;ADD(N)SUB PANEL(125 AMPS) 1. I have and will maintain a certificate of consent to self-insure for Worker's AND 60 AMP BREAKER-ISSUED 9/20/2017 Compensation,as provided for by Section 3700 of the Labor Code,for the 41100rerformance 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 permit is issued. Sq.Ft Floor Area: Valuation:$19800.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 18 057 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulation per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 'nature Date 9/20/2017 Issued by:ABBY AYENDE Date:09/08/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/20/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. f will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secti s 25505 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall �/nnA be deemed revoked. or authorized agent: vv r',_- APPLICANT CERTIFICATION .W9/20/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 9/20/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION [ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ))!! ,, C, 4yi.rsaf l` l (408) 777-3228 • building@cupertino.org PEMIT#B- Z o 11 1. 5 CUPERTIN© REV# a- DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS ©O 19 O M 1, \c. /I I a ! ` APN# n� 1i OWNER NAME C /`o h3 N I PHONE (�C�; ✓'541 0.40 E-MAIL STREET ADDRESS 100 1 q ©a Kt'Co+ ?I a L C�•uk ( tn© CA '1 5" 11-/ CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME ✓-`LICENSE NUMBER LICENSE TYPE IC0ba14 p�,xde✓ FIs1.e1 $Z0 (DC(7 C---- C) STREET ADDRESS2 5 5 ? U y,60-1-14 oNE E CTl Y STATE, ZII' �� C i I Moon-I c,;n View C71 Li y P -a-IlanUhaPCoboft�bw.Q.C Cos) II 5 I O Ek ❑ARCHITECT 0 OWN ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT 1US.LIC S CONTACT NAME �� E-MAIL I G14 t CI Y`C' k.0 VY\(0 STREET ADDRESS CITY,STATE,ZIP PHONE DECRIPTON V 1 S t o r - i t Sic en 1 I N. NIA i -t--5 O out-H-Q 4. -,2.ed 125 4 sRb ---10 Curv-Ih Y't ?`J C 'I'(LA -A-J w/ God bY..Pc Y ;✓1yna I r sie vv i c t , ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SFI PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF - SF 0 DETACHED EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO 0 NO 0 NO DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER uNiTs# UNIT ADDITON: 0 NO S F POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF REC VED BY: TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval (1 ./A p,-,,A RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES EI WOOD SHAKES El WOOD S IHIN� G S❑TILS OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD D 1/" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS El YESI #OF LAYERS THICKNESS❑5/8" OTHER 0 OSB ❑CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER 'Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspectio purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: �, Date: '1/2 / SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association B1dgApp_2017.doc revised 08/01/17 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1495 10019 OAFLEAF PL CUPERTINO,CA 950141127(326 18 057) COBALT POWER SYSTEMS INC MOUNTAIN VIEW,CA 94043 OWNER'S NAME: CHONG FAY JR AND EDITH S TRUSTEE DATE ISSUED:09/08/2017 OWNER'S PHONE:408-313-9026 PHONE NO:(650)938-9574 LICENSEDLICENSEDLOSTRACIMEDECLARAICHM BUILDING PERMIT INFO: License Class C-10 Lic.#820697 Contractor COBALT POWER SYSTEMS INC Date 06/30/2019 X BLDG _ELECT _PLUMB _MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N)23-PANEL ROOF MOUNTED PV SYSTEM(7.71 KW) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as provided for by .ection 3700 of the Labor Code,for the performance of the work for which this permit is issued.61p, Sq.Ft Floor Area: Valuation:$19800.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 32618 057 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant.understands and will comply with all non-point source regulations per themeiii• :*'Ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur.#,_a „�_ Date 09-8-2017 Issued by:Kim Dunbar Date:09/08/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors•to construct the project(Sec.7044,Business&Professions Code). Date:09-8-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO.BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain'Worker's Compensation Insurance,as provided for by. I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the,performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ an yperson in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,'Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized a 0 9-a' APPLICANT CERTIFICATION Date:09-8-2017 I certify that I have read this application and state that the above information is CO ` 'UCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify,and keep harmless the City of Cupertino against liabilities, judgments,costs;and expenses'which may accrue against said City in Lender's Address , consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Signature Date 09-8-2017 Licensed Professional \ i/j' ALTERNATIVE ENERGY PERMIT APPLICATION AE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building at7.cupertino.orq PROJECT ADDRESS { 0 0 131' O alp I_a I ?I a C-a APN# 3 / _ — I g OWNER NAME •Fo 12E1^ CI^ona PHONE Li�_3I2_°oa/_ E-MAIL STREET ADDRESS O 000/N ll Cho f�l�,n CITY, STATE,ZIP IA fl r-[ �ol SCC 615011_1 FAX CONTACT NAME Tatiana Haimo r �C PH°' 650-4417-5178 E-MAR.tatianah@cobaltpower.corn STREET ADDRESS 2557 Wyandotte Street CITY,STATE,ZIP Mountain View, CA 94043 FAX 650-938-9573 ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR ❑)CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAMECobalt Power Systems Inc. LICENSE NUMBER 820697 LICENSE TYPED-10 BUS.LIC# C°MPAN"NAME Cobalt Power Systems Inc. E-MAItatianah@cobaltpower.com FAX STREET ADDRESS 2557 Wyandotte Street CITY,STATE,ZIP Mountain View, CA 94043 PH91650-938-9574 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF X SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: 12 Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes 0 No SOLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: Z ? KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: $I� zoo 00 DESCRIPTION OF WORK S�U \ 1 i1 I k W PJ solar O Y� Sins-1 a l I 125 A- Sc&bpa.n-Qi• RECEI.Avk BY/0: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e pro.erty owner's behalf. I have read this application and.the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building onstruction. I authorize representatives of Cupertino to enter the above-id ntified p operty for inspection,purposes. Signature of Applicant/Agent: Date: Oct 07 7_6(7 ' SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY, W 0 OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD 0 LARGE ❑ MAJOR PVApp_2011.doc revised 03/16/11 �C.0BALT POWER SYSTEMS INC. Permission Letter to Pull Permits July 25, 2016 Cobalt Power Systems, Inc. hereby gives permission for the following individuals at Cobalt to submit for permits, pull permits, and sign for permits to be issued at any jurisdiction: John Juarez Tatiana Haimo Evan Haskins Allen McAllister Patrick Wamsley Bonnie Corwin Coreen Battiato Natasha Sherbaf Destry Jones Quynh Vu Nicholas Castillo Irina Zavgorodnyaya Ricardo Mercado Vince Valencia Rafael Mercado Luke Clardy Nathan Porter Vincent Jolissaint Kris Legnitto Ryan DalBianco Sincerely, ZIP/7Z; Mark Byington President Cobalt Power Systems, Inc. Cobalt Power Systems,Inc. 2557 Wyandotte St.Mt.View,CA 94043 T 650-938-9574 F 650-938-9573 www.cobaltpower.com . r V" .`'. SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE . ^` 3 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 • buildino(a cupertino.orq ' � 'EE I: W"figOV ED�S: TL HIS ERTFCATII ASBRgitte44 e� iw � �tjf ,- p �i ` " ��� c kt&W„,;:eltile " ' xo-u.,:.d.�.,.r .rxx,.,..�a...w-aa,a,� s,::r.,.-M:a<.ns>u.�.e»�w,.s:. n¢_.o.,..�ra,�.ww.. r . . .r,.wn.n ..�.4n.. aa..acxwau..a...,..a... ..,ae..*„��i,•�*-;'„-a'.ti, PURPOSE ` This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X "Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with i' CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s)may be solely battery operated; In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do ,not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl , •' !,space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for ':alarrins which must be connected to the building wiring. 4j. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been "installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the 'date signed below. • ,Address: /60 19 CMLe4-1= C'LPc,a-7,A)0/ CAL 9S PermitNo.g---2-0i7gS Specify Number of Alarms: t Smoke Alarms: L� #Carbon Monoxide Detectors: 1 have read and agree to comply with the.terms and conditions of this statement • Owner(or Owner Agent's)Name: C�011/ Signature �� s t.N i )(off 2 47 Date: Contractor Name: Signature Lic.# Date: Smoke and CO forrn.doc revised 12/15/16