06080041 1
/ CITY OF CUPERTINO � � +�1•a&+�' � "mLg �°a�,�`"
BUILDING DIVISION PERMIT CQilEICRAVITI P ORM
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BUILDING ADDRESS: PERMITN0.06080041
1375
R'S NAME: PERMIT ISSUE DATE
GREGG C BUNKER
PHONE: SAMTARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MFCH O
Go LICENSED CONTRACTOR'S DECLARATION lb Description
�+ I hereby amm Nn
r1 am Ikonred undero
provisions of Chapter 9(commencing P
with Section 700U)ofDiviaion?Orion,Business and Professions Code,and mylicens is
mfanmrceandefreca REVISION S2 & S3 & RETAINING WALL
q i License ClassLk.11
Date Contrmlhr. ORIGINAL PERMIT 05030230-NO NEW PERMIT
4 ARCHITECTS DECLARATION
i g 0 1 understood my pluu shall be used as records
public rords
i�
'p Licensed Professional
'y I OWNER-BUILDER DECLARATION
i i 1 hcrehy a sm that I am exempt from ore Conteao hr's Llecom Law for Uat
:00 fallowing out(Section 7021.5.Business and Profuniom Code:My city Or county
119 which requires a permit in construct,eller.bnpmw.demolish,or repair any structure
.zon
poor at its usuanm,alae requireslhhapplicant for such permit to Ole a signed suermon
•€< Nathe ulimtssd purmantto the pm,isiomofde ConreclerslJmnm law(Chaptar9 Sq.Ft.Floor Area Val$$i�t}718
$ (commencing with Section TOW)of Division 3 of the Besimmond Professions Code)-1
•�..
that be is exempt IMsefmm and the basis for the alleged exemption.My violation of
Section 7021.5 by any appilam for a permit mbjew the Applicant m a civil Penalty or APN Number Occupancy Type
not mom Nan Rw hundred dollsm($500). 36619071 . 00
O 1,as comer of the property.or my employm with wags as Jath sole compenandon,
will do the week.and the amctareianot mmnlledoroffered for sale(Sm.70".Business Required Actions
and Pref namoss Cock:The Grommet LIKMC Law does ant apply m an—Of 9 P
property who builds or improm thcmon.and who doessuch wark himself ar dim igh his
ownemploym,provided that such impmwmem see not Intended oronered for ole.If.
however.the building or Improvement Ice sold within oro year of completion.the Owren
builder will have the burden of proving Net he did not build or Improve far purpom of
co I.as Owner of ct properly,ec.704.B esnes,any commons with licensed contn[Im m <
mom La the pmka(Sec.70x4.BuUnm ask property
who
Cade:)M Cmhacmre U.
come law dole not apply e ts owner of pmperty who d p or Improves Come and
who contracts forsmh projects witha cantreamr(a)Iicenmd pursuant m Ida Contrsomh
me law.
olI am exempt order B d P C far Nis moon •�
A• WL —Dam HIM azo C
WORKER'S MPENSATION DECLARATION
1 hereby affirm order penalty of perjury One of the following dedearatione
❑1 be.And will maintain•CeNnale of Cement m self•insus,foeworkeracompcn-
satior,as provided(m by Section 7700 of the labor Code.for the per(ormanm of the
work for which this permit is leaned.
❑i haw and will maintain Workers Compeaudou Imumnw,u required by Session
3700 of Ne Labor Code,for the performance of the whsle for which this Permit is Issued.
My Workers Compemadon hence re career and Policy number am:
Canner. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not Mcompked iftie Permit is Throne hundreddi lan($Iol)
or leu)
I artHy that in the performance of the work fa which this permit is blued.)!hail not
employ any Person in any msntxm u m beeomcmbject m the Workers'Compensation
Laws of Cali(amiApitgpnC� -
NOTICEt PLICA
NOTICE TO APPLICANT:If,after Compensation
this provisions
hale of Exemption.Labord You ehme n
become h co subject m the Workers Con.Or Uon Permit
of the ladle Coda you mean
.,O (aMwiNcamply with such povksihns car Co.permitUWl he deemed muted.
z CONSTRUCTION LENDING AGENCY
[-t4 1 wiceyaffirm NU Nee faacomhvctinn lending agency for Nit partotmenauf
a the ,it for which this permit is issued(Sm.3097,Cls.C.)
� ~n. Lenders Name
] z Lenders Addmv
U C) I certify that I have read this application and state the the abow infmmatiun It
L[.P correct.I agree to comply with all city and county ordinances and sum laws misting to
O V building construction,and hereby authorne representatives of thiseity m enter upon[be
4 above-mentioned property for inspection purposes.
(We)agree to save,indemnify and kc,p hasmles the City of Cupertino against
ti vl llabilities,judgments.costs and expenses which may In any way aeon againal said City �s
U z in consequence of Nn,granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (/ G-
SOURCEREG TION� /
�• "- ��� O Ja Re-roofs
Signet of Appl ler Dae C
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building o[cupantalom or handle hauNau material
u defined by the Cupenino Municipal Code,Chapter 9.12.and tie Health and Safety
.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yen IgNa
Will the applicant or futum building occupant use,equipment or devim which If a roof is installed without firs[obtaining an inspection,l agree to remove
emit hvardom air Cinnaminson;u defiled by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yes I?No
I hew mad the huardsmr malerials requirements under Chapter 6.95.(ft Califar-
meHoaldt&SalctyCade,Semau 25505.25532 and 25534.1 urdcmand NuNone building
does not currently ham a school.Nat It is my rcapomibilfty m nodfy the haupant of the
require sew hmm met poor toiuvanmofaCatiMaeofOjmpincy. Signature of Applicant Date
4 g�t4 '09;1 All roof coverings to be Class "B"or better
Owneror aothodycd agem Dam