06100151Q CITY OF CUPERTINO
BUILDING DIVISION PERMITI�1F()RiTIQN,:
BUILDING ADDRESS: PERMIT NO.06100151
1375 S DE ANZA BLVD
PERMIT ISSUE DATE
OWNER'S NAME:
GREGG C BUNKER 10'/26/2006
)NE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION Job Description
U
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
2uw with Section 70(10)of Division 3 of the Business and Professions Code,and my license is
>>y in full force and effect REVISION: PODIUM BEAMS/GIRDERS REBAR
j,n? License Class Lic.#
t-o Date Contractor ORIGINAL PERMIT #05030230
to ARCHITECTS DECLARATION
R
I understand my plans shall be used as public records
U
,a
I- Licensed Professional
OWNER-BUILDER DECLARATION
a I hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Vale 7 18
r[- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 36619071 . 00
❑I,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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
buitder will have the burden of ving that he did not build or improve for purpose of
sale.). A
❑1,as owner of the p,y,a ez ive y'c micting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
ccase Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
❑1 am exempt uncder Sec. B&P C for this reason
Owner .4• `',A Date 147
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Clzur Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EX PTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($10()
or less.)
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 u to bcc me subject e V r c 'C pensation
Laws of California.Date
Applicant • ,C
NOTICE TO APPLICANT:If.aftc akmg thiscrtifica c of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z""t CONSTRUCTION LENDING AGENCY
Fr I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(See.3097,Civ.C.)
WCI,Q Lender's Name
Lenders Address
U 0 1 certify that I have read this application and state that the above information is
V. correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tFr C,4) liabilities,judgments,costs and expenses which may in any way accrue against said City /
I;,,)2 in consequence of the granting of this permit. y Date CG ��
t"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOURCE REGULATIONS. Ats 'O
f4r4. �1 I/ Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yeso
Will the applicant or runt building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or fu�,
-mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes tic No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements wbi Wet prior to issuance of a certificate of Occupancy. Signature of Applicant Date
!L NAV
Owner or authorized agent Date All roof coverings to be Class"B"or better