00100139CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDINO ADDRESS: a
-
PERMyr NO.
U J /
bb V.ICKbI3IJHW—
OWNERNAA'AllDR
APYLICA'1' i
IPUDNF. WALTER GYGER
SANT ARY 'r_' dOOS No,
RCHITRCTIENGINEER:
RUILDING PERMITINFO
BLOC, lil.[CI' PLUMB h11iC11
Gd L_7
LICFNSED CONTRAClOWS DECLARATION
Description
1 hnvhy atLrm that [.in littn.wd under Wnvi,inm.l CM1a.ur 9laonmmemcing
,lob
d with Section 70di Divisin 13 ofmc Business and Permission, C,Me,m,d my license
'
jis in all fume and eRoe.
Lianm.w Claw I,ic. p
Date Cnntn,cmr
PV PANELS ON THE ROOF ELECTRICAL CONNE
n ARCHI'1'IiCI'S DECLARATION
j 1 nmwromnd ney Plan..hau he "I'd a. pm,Ec recent,
MAIN AC PANEL.
-
J I.iceaved Profic-nnal
OWNIiR-IIIJIM)HR DECLARATION
I hereby affirm that I um vxcred from the Contractor', Lieen¢ Law fm the
i hollow., mann. (Section 7031.5, Bminess and Pofe,siom Gale: Any city n. county
which require, a permit to common, he,, impoee, demolish, m repair any structure
- prior o its issuance. atm requires the applicant for such Permit o file a signed statement
Sq. Ft. Floor Area
Valuation
- 'hat he is licensed Pursuant to the pros ision, of the Comments's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and IMdessions coal
or that he is exempt the cl oat and the basis for the alleged exemption. Any vinlation
of Section 703 LS by any applicant h.r it p nowt subjects the umber n to a civil penalty
A PN Number
Occupancy Type
m,I latae than fisc l„.reined dull;... S%n.
Yyyat
ry I.... owner of me F operl , m my entrinyccx with wag.. as their sole mmprnnaiion,
$ 2Rl00
Required Inspections
..It do the wad, and thn soccone i, not intended or uttered to sale (Svc. 7Z,
law does
Baines and Prom,inn, Code: nate Contractor's License an apply to an
weer of property Who build, or Imprnes thereon, and who des such work himsch
36907005. 00
or through his own cmploye... .... idled that such im ow,i ems are not beeanded nr
ollered for sale. IL bmevcr, the building or inm emerrere is sold within one year of
ompletion, the ow mebuilder rill have the burden of moving that he did not build or
impLwrfor purposeofaale)Y
304 — ROUGH ELECTRICAL
W. its owner ofthe progeny, am eWiwively contracting with licensed contractors to
501 — FINAL ELECTRICAL ENERGY
the project (Sees 7014. lbione,s and Pmfeuions Code:) The Contractor',
Lconstruct
iice,,c Low does a.t apply to an.wn., of prnpany who builds m improve memon.
505 — FINAL ELECTRICAL
uuI who comma, far suchpmj,,t with a rootmmm(,) licensed .mount a Die
Cnnuumor, License Law.
01init Scc._ II& 1' Clin'IIii, uaam
Owner u we ����
F
-
x' K ?R'S CO,MPEUNSASdON I.AR ION
I hereby affirm under Penalty of perjury one of de following declaraborr,
f0 1 have and will maintain a certificate of Consent 1. elf -insure Por Worker',
Compcmation, a provided for by Section 3700 of the Labor Coda far the
/
prformance ofthe work for which this,rrrmt is issued.
/
hove and will maintain Worker's Com.enmlion Insurance, as required by Section
/f
+ /
3711, of the Labor Code, Iimr the Perl'nnnm¢c of the work for which Thi, permit h
"sued, My Worker, Compen,doou I...ur.nce caul,, and Policy ounhur an:
Canice Polley No.:
CER1IFICATION OF E%EMI11KIN FROM WORKERS'
' COMPENSATION INSURANCE
(lTis section need not be completed if the.coil is for crit hundred dollars
($100).. loss.)
1 verify that in the Performance of the work for which this permit is issued. 1
shall not employ any Person in any manner so as to hammc subject to the Workers
Conmen.m u m laws of Calilorma. Done
Appllemr
.
N01 CE'r0 APPLICANT: If: after making this Cenific to of E.e n noun. you should
In, ,objeamme Wader, Con.pm.... pre n .f she Labor Cada Y., nus
.hall
Ibtllmwim comply with such pnn'i,ium nr isPcmdi he discoed re,oked,
0 CONSTRUCI ION LENDING AGENCY
I hereby iffmnn thus them is a construction lending agency for the Pcdimnance
of the work foe which this permit is issued (Sec. 3(197. Civ. C.)
'
] Ixndch Nanm
Ixmder',Addrea
1 certify that I have mad this application and state that the above infomnotom is
correct. 1 agree to comply with all city and county ordinances and state laws m6ting
nm budding comtfuctinn, and hereby authorize repmsenrativcs.f this city R, enter upon
the uhuvc-ometioned pngmny or impcca.n purme,es
y (We) ugmc m,me, in Janne, y and Ace, harmless the Gty od Cuperino agaimr
0 l inhilitiv,. judgments, co.I and eapcnaro whieu Bay in any way accmv egulnst said
Cityineanaquenc. of t he grant in, of tbi, permit.
TUN [RS'1'ANDS AND WILI. COMPLY WITO All.rNaOON Fes N'f
/ Date C�
AYI'h1'A
SOUR
Issued b y V
e!t%U'
Re -roofs
Signature in mraeam. )ate
uteS A1ATgocA1.SDISCLOSURC
\VIII the...beamm more building occupied naeor,atone
f or
.Type Of Roof
Health Safety
the Municipal Code. Chapter 9.12. and the health anJ Safety
Cde.iScene 3200?no
Code. $Javan 25532m1^
All roofs shall be inspected prior to any rooting material being installed.
Will the a.phcmri nr fano hai ding ocempam use red Precut or device, which
If a roof is installed without first obtaining an inspection, I agree to remove
eutit hazamlouse u enmomin:mtn as defined by the Bay Area Air Vriu1Ry Mnnagenmol
Di,o-ictO
all new materials for inspection. ApplicanLundcrstands and will comply with
vat YI No
all non -point source regulations.
I have read he ha,wdou, neutniul, m,.ince cnts ,order Chapter 695 of he
California Heim & Sato, Code, Serino, 25505. 25533 and 25534, 1 undersmed that
If the building docs num croscntly have a mount. that it is my responsibility In notify the
occupant o the ram', menw which must he met prior to issuance .f a Cerilicam of
'x'mpaneSignatore
to �?.VjZ.lVo
of Applicant Date
be Class "B” better
Dare
All roof coverings to or
er or authorized