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02060014OFFICE CITY OF CUPERTINO BUILDING DIVISION PEAT - " 1, CONTRACTOR 1NFOIWV ION- , BUILDING ADDRESS: PERMIT NO. 10165 VICKSBURG DR WALTER GYGER 02060014 OW NER'S NAME: APPLICATION SUB DATE WALTER GYGER 06/04/2002 PHONE: SANITARY NO. CONTROL NO. 0O Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH <i I__7 L3 L. 1_.r' y i LICENSED CONTRACTOR'S DECLARATION Ihemby lob Description :o i— aB7mlhm lmnlicenaed under provisions of Chapmr9(commencing with Section 7003) of Division 3 of tim Business and Professions Code. Old my license SOLAR PANEL ADDITION is in full force and c1&ct. s a i License Class Lic, a ti. Date Contractor ARCHITECT'S DECLARATION w 3 1 understand my plans shall be used as public records Y p0 Licensed Professional R 8! OWNERat ? < I am BUILDER m the CoATION License Law for she I hereby aRrm that 1 1.. Burin from the Cosions fallowing reason. (Section ]031.5. Business F O e C c and Professions Cade: Any city or county which requires a permit to const 1. eller. improve, demolish, or repair any structure $6000 3'k'. sm _ prim to its issuvrnce. also rego for Lowdnammem t+II��QOT/A�ea.,, Valuation Y". ; ,provisiosof ContractorsLicense (c6m. is thin°(heprovisionsofofamBucmisLindPir.�wmorCac) (Chapter 9 con, with Section 700.) of Division 3 of Business and Codc) ny aingwd, or Shan h'e 7 a e alleged aM the basis for the ion Any Vi sang 3' r ' ctstpvempnon 31.5 b a [i l pennon of Secsian 90J LS by any applicant for a permit subjects the applicant m9 evil penally action ortthmr hand ed.1 (5500) .�I,�� p Occupancy Type '304APNMaiah ❑ 1, as owner of the progeny, or my cis o with wages their solo compensation, ELECTRICAL -will dot work, and the t in not intended Decree for sale (Sec. a '- -FINAENERGY -- - . to an Bu a ode:structureTo C Profession Code: The Conaea a License Lew docs not apply so an ❑fin ,t% 5 0 5 — F FINAL ELMM4ZI- l:,'yj�PC[IODS ownLECTRIGA13 0 er of poi res wthr of Who loilea m improves Merton, and who does such work himself his Ow or through his own employees. provided Net such improvements not emended or ,offered! If; however the building orurden vemym n role within one year of is sol within fon. F�NALED niple the completion, the owneobuilder will have tM burden of proving Shashi did not Wild or ' improve for purpose of seleJ. _ -. - -.0000.. Ne property, am exclusivelycommfessiwithlicensedo ._ -. 'JUL 2 2 2002-. 0000 - ' coLtrownerpr c icense the pansies (Sec. Business and Professions Code) The Contractor's mr'e License oejownerof to a improves the who)lidsseor improvesttothe apply tPmjccts Amperty and who contmco for. such with,a [onsrml°r(a) licensed pursuant to d% CommsLawvoense Cont/ hoc License Law. -- BUILDING ❑ I em exempt under Sec. B & P�C for this mason GWlldr✓a1A�T G(b Date / 2 ' l WOR R'S MPENSATION DE IAR TION RATU)N I hereby affirm under pcnalry. of Perjury one of the following declamations: ❑ I hive and will maintain a Certificate of Conant to self -insure for Worker's Compcumion, as provided for by Section 3700 of the labor Code, for rhe ' 'Performance of the work for Which this permit is issued. ❑ 1 have and will mil Worker's Compensation Insurance. as required by Section ]]00 of the Labor Code; for the Perfarmance of the work for which this permit is - issued. My Worker's Compensation Insurance carrier and Policy number ere: ... Carriec�,'.1 ...; ..�. .'p :'.;' . Policy No.: CERTIFICATION OF EKE1,1MON PROM WORKERS+` COMPENSATION INSURANCE' % ' ...,..... .•.... .. .. .. ... .,.., 0000, .. ._ 0000 0000 0000 .. _. 0000___ _0_0_00 0000.._. .. 000__ .. ._. .. `(This icmion need nos he completed if the permit is for one hundred dollen " -• (11 My or less.) - ,, mcempl Iyer in the performed�asf thework'far which thispermit rs Issued, I shall not employ any n any in er s Workers 0000. -- • - person t co a object {p the Co pe s ares l,a of Cgbf m Dmf`' L � .APPI CSnf L-1ws L'1 Nth APPLICANT: It. after making this anifican, of Exemption, you should beco' mbjen to the Worker's Compensation .. ... .. _ provisions of the Labor Code, you must fodhwas comply with such provisions or this permit shall he deemed revoked. i.> 1iCONSReUCT10N LENDING AGENCY " I hekby affintohick this shore is lending agency for be performvnce issued _ . sr Of work for which this permit is issues (Sao. 3097, Civ. C.) is (Sao. 'IQ Lena Lender's Name '' �...... ... s'- .. :Z Lender's Addrtss•, ;Q y . 1 unify than 1 hely rtad Nis sca a'km it c6uem I agree tq to mp vote shin she above information is .(~ comply with ell ciry and errand city ands ie mcea and area lows of'shis ciry mercer upon the . [�] aildingmnstmction,andheit,bort lime&p.aensativo she ebov to property forinspersionpurposes. .0., 'VJ ic)agree (We)dgme to sown indemnify me keep homy to of against liabilities. judgmegts, casu and expenses which may in any way acorea egainn male an way drum again., Cisy in pnsequence of the of thii gaming permit. APPLI ANT UND 'B":HI COMPLY WITH ALL ' NON OI\T' SOU : RE . �. Issued by: Date 2d N46_tgnatgreo AppBc` tractor to — Re -roofs ARDOUS MATERIALS DISCLOSU ^' Will the ePpli orfuture building occupant store or handle tiarardous material 'ai Type of ROOF defined by the Cupertino Mmompal Code; Chapter 9.12, end Ne Hedth and Safety •.. •' '�. Code: Section 35532(e). '00 0 0 ', ' .. '�,�"° -' - - r3Yci �^' ,. • .. ' : p I'' .' " ' All roofs $hall�be inspected p _ rior to any, roofing materia] being installed. islet hw. the app"Beent.or fm;mw building occupant u¢ equipment or devices whim a Me- If a roof is in§tolled without fust obtaining an inspection, Pagree to remove eucontaminants as defined by Ne Bay Arm Air Quality Management Distrot'; 03 '.....°... all new materials for inspection. Applicant understands and will comply with . all non -point source regulations: " I lmiocl eod she haterdom-no.c eels %quiremcnIs under Chapter 6.95 of the Cdifomia Health k Safety Cade, Sections 25505, 25533 and 25534. 1 undersand that ifibe Wildingdoes not cuttensly have a tenant, shads is my responsibility to notify the - occupant of she requirements which must he met prior to issuance of a Cermiicam of OcmPg�ry.� L: y , �f 6•et Q'QJ \ 6r„/., Signature of Applicant Date -' owner pr.amar:ed,gent .. Dial All roof coverings to be Class "B” or better , OFFICE Sn CITY OF • CUPERTINO 0 CITY OF CUPERTINP PERMIT APPLICATION FORINT !APN # � / � Fee Group Date: Building Address: l O / r1 (� Owner's Name: 4 / Contractor: 9 �r OFFICEFEE Phone #: S/o -936 -2 2Sy �fo8—ZCZ—o88 License #: Contact: BAPPLOTHER Other A—ppliances Phone #: Applicant/Contraptor: Construction Tax BUILDING Fax #: g Permit Info: Elect R Plumb Mech tial: on:tial: _.. �2 e Sq.Ft. Floor Area: BUILDING BCONSTAXR g/ t.; Architect/Engineer: BELEC1000 Elec 600V <-- 1000A Valuation!Goup: 00 i Type of Construction: Elec 600V> 1000A ELECTRICAL Occupanc uanti Fee ID Fee Description Fee Group APTFEE EACH STORY OVER 3 HOTELFEE EACH STORY OVER 3 OFFICEFEE EACH STORY OVER 3 BAPPLOTHER Other A—ppliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/COmm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <-- 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <-- 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Ener Add Multi BUILDING B]NVESTIGA Investigation fee BUILDING BMITIGATC Comm. HousingFee e BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-FamilyRes MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL 1 of 3