12040123I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10625 FLORA VISTA AVE
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class L— I b (� Lic. # k of Q (0 % 7
Contractor Calf C oWe✓ 5,S, Date !�- 16 - --
1 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.
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 whichthis 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.
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
S r� ra Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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 dhe performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that 1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOR: COBALT POWER PERMIT NO: 12040123
SYSTEMS, INC
885 MAUDE AVE DATE ISSUED: 05/16/2012
MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 938-9574
JOB DESCRIPTION: RESIDENTIAL u COMMERCIALU
ROOF MOUNTED PHOTOVOLTAIC SYSTEM WITH
INSTALLATION
OF 18 MODULES AND NO BATTERY BACKUP
Sq. Ft Floor Area: I Valuation: $35400
APN Number: 32608021.00 1 Occupancy Type:
PERMIT EXPIItES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY5, FROM LAST CALLED INSPECTION.
Issued by: 62 C Date: G(O
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance
25534.
O %er.or authorized agent: Date: I L I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Pro
Signature
Date
CITY OF CUPERTINO
W-W FEE ESTIMATOR — BUILDING DIVISION
19
ADDRESS: 10625 Flora Vista
DATE: 04/23/2012
REVIEWED BY: Sean
APN:
BP#: O
"VALUATION: 1$35,400
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
Roof mounted photovoltaic system with installation of 18 modules and no battery backup.
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Metrict- etc )_ Thn_ca fees are hated nn the nreliminaru infnrmatinn availahle and are nnly an actimnta_ Cnntart the Dent fnr addn'l info_
FEE ITEMS (Fee Resolution 11-053 F,ff. 7-1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$214.00
Alternative Energy System
1PHOTOVRES Photovoltaic System
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Strong Motion Fee:
IBSEISMICR
$3.54
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
�:.'l.
$5.54
214.00
aki:�.
219.54
Revised: 04/01/2012