05030118 CITY OF CUPERTINO Itt
BUILDING DIVISION PERMIT C®NT CTOR�INEbRMATIaNN
s-r 3 Ksa:a � 11 MAWR
BUILDING ADDRESS: /'„ /�,a/�i /.�a PERMIT NO.O S O 30118
ER' NAME: V/ T LCA. PERWT6SIfEDATS
BUNKER GREGG C 02/23/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINF-O
BLDG ELECT O O PLO O
LICENSED CONTRACTORS DECLARATION Job Description
�u 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
wWt Section TWD)of Division 3 of the Busineasand Professions Code,and my license is
m; In
full fnmaandiffeet. CONDO-3 STORY (2 , 682 ' LIVING)
!8
License Clue Lice Dam Contractor NEW ADDR WILL BE ASSIGN ON WILDFLOWER WAY
` ARCHITECTS DECLARATION
t I understand my plans alWl ounces!In public Teemed
io Licensed Professional
�.7�777 OWNER-BUILDER DECLARATION
i�g I hereby affirm that I am exempt from the Cenlnetor.License Law for the
p o following mann.(Section 703 I.S.Business and Profrstiom Code:Any city or county
$ which requires a Permit in ennuncL after.Improve,demolish,or repair any.tectum
�^ prior to its luuance,also requires the applicant forsuch permit to file ulgned statement
< that he is licensed pursuant mthe provisions ofthe Common's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Businosa and Professions Code)or $321840
— mat he in exempt tAerefrom and tie basis for the alleged caempdou.Any violation of
Section 7071.5 by any applicant for a permit suhis=the applicant m•civil penalty of APN Number Occupancy Type
ON mom Nan R.hundred dollars(M).
❑L u owner erfie property,army wployw with wage u Ileo selecul..alien,
will do the work.and the suucture I.not intended m.ftnad for age(Sec.7044,Business Required Inspections
and Profession Code:The ConuamnYs License, on law dtint apply m an owner of q P
property who builds or improves dumaon,and who dou such work himself or through his
own employees.provided thatsuch improvements am wt intended oroRered for We.1f,
however,the building or Improvement is sold within one year of completion,the owner.
builder II have the burden of proving that he did not build or improve(or purpose of
1, mvner of ct property,arm exclusively Ind
contracting with:)Th ed rent clues - /�C✓N /�
c t the Project(Ste.7044.Bosincu and ProGasiaes Code:)The CenusemYt Li-
< law dors nm apply m an owner of propeny.who huildi ser improv thereon.W,
whocon fm ouch projeeu vithatonuataor(s)Ilcensedpunwnam Ue ntrrtar's
Lktese w
❑lame em under Se .BQPCI t>,sen
r Dam G
WOR C PENSATIONDECLARATIO4
1 hereby affirm under penury of perjury one of the following declanalone
I h.va and will m W.win a Cenifium o(Conseni m wlfdnsum fm Wo k es Compery
anlon,u provided fm by Section 3700 of On labor Cade,for die performance of the
work for which this permit is issued.
❑1 Wve ant will maintain Worker's Compensation Iesunnce,Is required by Secdon
3700of Ne Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compecoul Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7husection need am becomplemd if the penult Is Intone hundred dollars(SIM)
ser loss.) 11
1 unify that in the perfmrneateo of M"Orl 'o hich thi,/ermi u IssuM,I still not
cmpleyanypersoninany anocran b0 om�t nu]A_ kers Compewtion
4ws of califomi&Dem
Applicant
NOTICE TO APPLICA g this ni tum of Exemption,you.trould
become subject to the Workers Coope tion provisions of the labor Cason,you mute
Z fothwith comply with such pmviainm or thin penniuhall be deemed revoked.
„z,i O CONSTRUCTION LENDING AGENCY
[r I hereby afTtmt that dere Is a comemlint lending agency for the perfurmmce of
0(i> the work for which this permit is issued(Sec.3097,Ch,C.)
oaQ Lenders N.rne
Z fender's Address
U0 1 coWily data 1 love mad this application and sum that the above infemudun is
D.f" corm I agree to comply with all city and county ordinances and sum Ism relating le
0 building construction,and hereby authorin represurenivea of this city to coker upon the
Wabove-mentioned property for ImpeNon purposes
(We)agree 10 ave.Indemnify and keep harmless the City of Cupertino agalnet
y IIeb1110es.ludg enu.comm petuea which may in any way accrue gainsa old City
U Ineomeynenc fthegranon a la permit. /L- 2'7•dL
APPLICANT NDERBTA DS ND WILL COMPLY WITH L NON-P INT Issued by: Date
SOURCE RE S. 'L>a
Re-roofs
Signuum of App f2elllrac Date
HAZARD S MATERIALS DISCLOSURE Type of Roof
Will the"'pliosnt or Futuro IdinL ecevpmttatorem bandlehuallommateriu
u dented by the Cupertino Munie al Cod,.CbepW 9.13,and the Hall,and Safety
Section 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee e
Will the applicant of future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnvaromes air contaminen u recd by Ne Bay Area At,Quality Managcmcna all new materials for inspection.
District?
Yns u
1 ve readthehxnrdousmatdalsmquhemeas underCTapuo&95oftheCalifor-
nuHeal SafetyOxic.Sceuoru 25505.35533 and 25334.1 underrated this ifft ing
does n ntly ha a tenant this it is my maPensihility m nail do ampam f the
mqul rich metpdormiuum.mofaccrncam Dec.--t. Signature of Applicant Date
owntr p amnen; D m All roof coverings to be Class"B"or better c