B-2017-1851 l CITY OF CUPERTINO BUILDING PERMIT
' BUILDING ADDRESS: CONTRACTOR: PERMIT NO:5..2.011-- 1$Sl
10751 GASCOIGNE DR CUPERTINO,CA 95014-3845(375 31 022) COBALT POWER
'SYSTEMS INC
- 'MOUNTAIN VIEW,CA
194043
OWNER'S NAME: BURGAN STACYAND WILSON KELLY 4 DATE ISSUED:Iof soIg.ot1-
OWNER'S PHONE:650-417-5178 PHONE NO:(650)938-9574
LICENSED CONTRACTOR'S DECLARATION '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 I ant 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)24-PANEL ROOF MOUNTED PV SYSTEM(7.85 KW);(N)
I hereby affirm under penalty of perjury one of the following two declarations: SUBPANEL(100 AMPS)
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 js issued.
ai '' 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:$18000.00
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 375 31 022 •
`
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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
t Signature Date 10/30/2017 IssuetLIty:
Dater�rx�.,�: _ . l013011L
OiNER=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 myemployees with wa es as their sole I installed without first obtaining an inspection,1 agree to remove all new materials for
P P Y• g"
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:10/30/2017
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
a. I certify that in the performance of the work for which this pennit is issued,I Hea •
lth&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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ! )
be deemed revoked. Owner or attthQrized agent
APPLICANT CERTIFICATION Date:10/30/2017 c "
II certify that I have read this application and state that the above information is' 11_-C6NS RUCTION 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.)
Ito enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
'Ito 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 10/30/2017 Licensed -
Professional
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@cupertino.orq
F, _7-ot1 —IBSI
PROJECT ADDRESS
1015 G aS C0;5 n e DrN,2
' T.^ APN# 3'—"/ 5 - ( ),I ,^ ozz
`/ C YJ�
OWNER NAME IAe LI1/44 + l;1Sar\ PHONE E-MAIL
STREET ADDRESS w CITY, STATE,ZIP FAX
CONTACT NAME Tatiana Haimo PHONE 650-417-5178 E-MAILtatianah@cobaltpower.corn
STREET ADDRESS 2557 Wyandotte Street CITY,STATE,ZIP Mountain View, CA 94043 FAX 650-938-9573
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TENANT
CONTRACTOR NAME Cobalt Power Systems Inc. LICENSE NUMBER 820697 LICENSE TYPE
C-10 BUS.LIC# �-
4o3typo
5
COMPANY NAME Cobalt Power Systems Inc. E-MAILtatianah@cobaltpower.com FAX
STREET ADDRESS 2557 Wyandotte Street CITY,STATE,ZIP Mountain View, CA 94043 PHONE 650-938-9574
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF tglSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE CI Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE 0 Yes 0 No
SOLAR PANELS 0 ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: ZII KILOWATTS(COMMERCIAL ONLY) TOTAL VALUATION: $(Ot000.00
DESCRIPTION OF WORK
a-611 7.85 kk1 PV 9olct.Y Or roofs' •
Npi 100 Su,bpareI.
RECbW
I re � c
lI�\
� A A
AGLI2S9/4
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the perty 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-id ntifie property for inspection purposes.
Signature of Applicant/Agent: Date: /���0�17
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTER
a.
❑ EXPRESS
U
U
❑ STANDARD
❑ LARGE
w
❑ MAJOR
P VApp_2011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE r
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
�Ss.9ss, I J ai
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•building cupertino.orq
is �� �,. s} � �`yam' � � w"� fin' i3�Ct ar �r 3 un;:int_� d ��k� K ���x-S".�N �'r ,�viv � y s;•
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Off, r r' t U CANNOT .F F[NAED=UNTII THIS CERTIFICATE AXS BEENt'
L ED,SIGNNED AA1D T, BTI D�SION
421,41.4
PURPOSE
This affidavit is a sell-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 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,R315, 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 the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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
CBC Section 420.6 and hall 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 lit 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
alarms which must be connected to the building wiring.
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 signedbelow.
y •'
Address: I0 GQS(p ✓t q e- Permit No. ( 7\rav
. J
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors: , Q !
I have read and agree to c mply with the terms and conditions of this statement
Owner(or Owner Agents)Name:. .
Signature.... ... ... �1� `„ `' ((Date:
Contractor Name:
Signature Lic.# t Date:
Smoke and CO form.doc revised 01/10/2017