05030120 CITY OF CUPERTINO 77777 11 � ' � ^A^-' `�
BUILDING DIVISION PERMIT `;CONTRr�5TURTNFO MATTON Mr
BUILDING ADDRESS: 05 03 012 0
NER'S NAME: PERMIT ISSUE DATE
BUNKER GREGG C02/23/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG
l� O PLO O
3ozp LICENSEDCONTRACfOR'SDECLARATION Job Description
1 hereby of lne Nat 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)ofDivldon 7 of the Businm and Professions Cotle,and my license is
mfoBforoeandeffen CONDO-3 STORY (2, 682 ' LIVING)
LiceDamomGlW Contra NEW ADDR WILL BE ASSIGN ON WILDFLOWER WAY
e3 W ARCHITECTS DECLARATION
Y ty7 1 n&.,..d my plana shall M used u public..,us
is c�a Licensed Professional -
3 OWNER-BUILDERexemptDE Ce Coram ON
I hereby elfmn that 1 1. exempt from the CahraemM1 Liease Law for mhe
COO following massa.Permit
t 7o sir B.alters and ",de ons Coda:Any cm or county
$ whish requires•Immo re sures ftt,Wer.,prove,h Permit t or repair any smaun
Prior m its issue=.dpursuant
powish i s of(or such permit m ick se Law ateemem
FF � twheisllcensodPutmemlatteprovivoaofNcConuecmrelittnselaw(Cheper9 Sq.Ft.Floor Area Valuation
Y€$ (commencing with Sallon70DO)of Division 3 of the Thromm amt Profession Crate)or . ,$321840
that he is aumial dumfrom and the beds for to alleged exemption Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicanm In a civil penalty of APN Number Occupancy Type
.1 mon than firs hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their dole compmuWon.
will do the war,and the lure s net Incensed or offered for sale(Sec.70th,Business RRequired Inspections
and Pro(cadion,Code:The Contracmr's Liceme Law does not apply m e ns an Owner a( q p
progeny who Wilda orlmprsvn terean,andwhadonsuch work himselforthrough his
ownemPloyen,provided that such improvements are notinended araffered for We.IL
h ern,Its building or smprovemenm I.sold within one year of completion.the awhnt-
bit tar will nave Ne burden of proving that he did nut Wild or improve for purpose of
1,a owner of tier property,mn nduatvely contracting with licensed conuaclon to
construct the project(See.70as,Business and Profnatons Cade:)The Conmemr's LI- r'
cons�owcfnw solapplyan.utownerofpmpenpwhe Wilds orimprov thenar. e , /J //q -•yv 7
who coLice ton 4 itch proJecu witheconuacros011ansed punammte Conuamor' d� �, / v v �✓ D/
❑lame u Sec. .BkPCfa s n
Due
W 5 CO ATION DECLARATIO
I he r penalty of perjury ane of the following declarations:
❑1 have and will maintain a CcNficataof Consemmself-insure(or WorkcesCmMn. .
nation,as pmvided for by Section 7700 of the Labor Code,for she perfarmuha of to
work for which this permit is issued.
❑1 have and will maintain Worker's Computation Insmaa,as required by Section '
3700 of the Labor Code.for Ne performance of the work for which this permit is based,
My Worker's Compensation Ioniums carrier and Policy number art: -
Carter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thla decreed aathecomFleed If tlaspermit is fo onehundretl dollars($1IX0
or lata)
I aNfy that In the pe urmance of or f wh' b NI pe It Issued,1 Nall not
employ any person in m nnerm w corn incl ti Compenanian
LawsofnyPe son I
Appllunt
NOTICE TO APPLIC e e aka hfaniR.uCof Exemption.you should
become aubject m rhe k 's mpewuon provisions of Ne Ichor Code,you moat
.JO forthwith wiNa hmvisinns or this Permit shall WtleomW revoked.
Z� CONSTRUCTION LENDING AGENCY
EI hereby affirm Nu tam is a consuucdon lending.gewy rot the per(u reams of
C$> the work(tar which this petmim is issued(Sec.3097.Civ.C.)
Ca hinder',Name
=z lender's Address
U0 1 unify that I have read this application mad ren that the above information Is
1.{"r macs 1 agree to comply with all city and county onlinamres and suw law miming m
C7C.) Wilding construction,and hereby authorise npresemative,of this city m cnwr upon the
U above-me ' ncd property for i- "mon purposes.
) rte soave.indemnify and keep harmlw the City of Cupertino against
Ly faq Iiabit itu Jud e...cmu ad expean which may in any Wyatt again,nail ly
U 7 I.'eruse of Nc Staling of Ni'"amid.
G APPLIC DERSTANDS AND WILL COMPLY WIT ALL NON•P Issued by: Date
SOURC R TIONS. yv
L Re-roofs �� ` ZL
Signature ( I r De
RDO Al RIALS DISCLOSU R Type of Roof
WIII c plicatorfumro building mcupamsmtcorhendle hatrdoua material
a da0ned by the Cupertino Mun ehpel Cocc.Chapter 9.13•and the Hcatlh and Safely
nae. [3Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yn
Will the applicant or(urea Wilding occupant un equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
emu hayardna air conumma defined by the Bay Area Air Quality Management all new materials for inspection.
Diavicl7
[3 yes Nu
Ihave mW the hasrdmhsmakrtalstaquirementswder Che rQ95 ofdn Cal on
nu kSatcIYC ,Semions25S05.75533 uW7553/.i if he
W'NnS
don urmntly ltave anal,tut Ire b o, nspansihil' fyyhe uP•nt the
req re me tolasaenttancett a(Okmp t• Signature of Applicant Date
own ons . a'
D6 All roof coverings to be Class"B"or better v