11040113CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10965 MUZAMONTE RD
CONTRACTOR: COBALT POWER
PERMIT NO: 11040113
SYSTEMS, INC
OWNER'S NAME:
MOUNTAIN VIEW, CA 94043
PHONE NO: (650) 938-9574
❑ LICENSED CONTRACTOR'S DECLARATION
F
n Lic.# U
License Class 0-Q
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH rRESIDENTIAL FCOMMERCIALContractorCawouwsw.
Date
1 hereby affirm that 1 am licensed unde the provisions of C apter 9
JOB DESCRIPTION: INSTALL BATTERY BACK-UP FOR EXISTING
(commencing with Section 7000) of Division 3 of the Business & Professions
PHOTOVOLTAIC
Code and that my license is in full force and effect.
SYSTEM INSIDE GARAGE
1 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.
have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $25000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35601032.00
Occupancy Type:
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
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 rmit. Additionally, th plicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non-
ILDER DECLARA ION
LL
RE -ROOFS:
hereby affirm tha 1 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.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
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
in in compliance with Pe Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
.)
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 permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10965 miramonte rd.
DATE: 04/18/2011
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: 1$25,000
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP8
PERMIT TYPE:
WORK
install battery back up at existing garage location for an existing solar panel.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Other Power Devices
1BREMPOWER
1
#
$158
TOTALS:
$158.00
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 1 0.0 1 hrs 1 $42.00 1
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 gL 711110)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
",. cr .
PME Unit Fee:
$158.00
PME Permit Fee:
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
/lief"Irvin.-
i
Travel Documentation Fee: ITRAVDOC
$42.00
Strom; .Motion Fee: IBSEISMICR
$2.50
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $245.50
$0.00 TOTAL FEE:
$245.50
Revised: 01 /15/2011