B-2018-1363 CITY OF CUPERTINO BUILDING PERMIT
BUILDINC ADDRESS: CONTRACTOR: PERMITNO:3-2018-1363
888 BROOKGROVE LN CUPERTINO,CA 95014-4634(375 39 04D) COBALT PO WER
SYSTEMS INC
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: DATE ISSUED:08/13/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CIO Lic.#820697
Contractor COBALT POWER SYSTEMS INC Date 06/30/2019 X BLDG ELECT_PLUMB
I hereby affirm that i nm licensed under the provisions nlChapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
With Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)14 PANEL ROOF MOUNTED PV SYSTEM(4.578 KW)
I hereby affirm trader penalty of perjury one of the following two declarations:
r. 1 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,far the
pet pannance of the work for which this permit is issued.
2. 1 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
is issued
Sq.Ft Floor Area: Vnloatian:$12659.00
I AYYLICAN'P CER'1'IFICAI'ION
certify that 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 39 040
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.
Signature Date 08-13-2018 Issued by:Kim Dunbar
Date:08/13/2018
O ER-B LARA770N
I hereby al'Brm 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 raofurg material being installed.Ifs.of is
n. 1,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 structureis not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofAppliesnC
contractors to construct the project(Sec.7044,Business&Professions Code), Date:08-13-2018
1 hereby affirm anchor penalty of perjury one of the fallowing three dednrutlons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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
x 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 Coda,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I, 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 on in an manner so as to become subject to dna material.Additionally,should I use equipment or devices which emit hazardous
1 y any person y J air contaminants as delined by the Bay Arca 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 suit
exemption,f become subject to the Worker's Compensation provisions of the the Health&Safety Coljo;S`tions S 5,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Date:08-13-2018
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 stale 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 MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Sig natureLicensed
Date 08-13-2018
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1363
888 BROOKGROVE IN CUPERTINO, CA 95014-4634 (375 39 040) COBALT POWER
SYSTEMS INC
MOUNTAIN VIEW, CA
94043
OWNER'S NAME: DATE ISSUED: 08/13/2018
OWNER'S PHONE: 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
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N) 14 PANEL ROOF MOUNTED PV SYSTEM (4.578 KW)
I hereby affirm under penalty of perjury one of the following two declarations: REV # 1 - ADD SUB-PANEL NEXT TO EXISTING MAIN SIDE OF
1. I have and will maintain a certificate of consent to self-insure for Worker's HOUSE - (100 AMP).- IS SUED 1.2/19/2018
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
n Sectioe. 3700 of the Labor Codfor the performance of. the work. for which this
s
permit is issued. Sq. Ft Floor Area: Valuation: $13159.00
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 39 040
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.
Signature Date 12/19/2018 Issued by: Kim. Dunbar
Date: 08/13/2018
OWN,. R-BUILDER DE"CLARATION
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: 12/19/2018
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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 authorized agent: ,,/
APPLICANT CERTIFICATION Date: 12/19/2018
certify that I have read this application.and state that the above information is CONS`. I CTION L DING AGENCY
correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that thgte'is a constrtion 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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 12/19/2018 Professional