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CITY OF CUPERTINO
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CONTRACTU#RI�NFr SRM A'C,IONx;
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
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PUMITNo.05030121
ER'S NAME:
PERMIT ISSUE DATE
BUNKER GREGG C
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NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG PLUMB MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that 1 am licensed under provisfom of Chapter 9 (commencing
with Section TODD) dDivision 3 of the Business and Pra(eniuns Code.and my license la
In Mull tome and effect.
CONDO -3 STORY (2,6821 LIVING)
License Class
Dale Ccontromaactor
NEW ADDR WILL BE ASSIGN (WILDFLOWER WAY)
ARCHITECT'S DECLARATION
I understand my plain shall be used an public reeordn
Licensed Profcasionai
OWNER -BUILDER DECLARATION
1 hereby intim that 1 am exempt from Ire Contractors License Law for the
fallowing reason. (Section 7031.5, Business and Professions Cade: Any city or county
which requires a permit W ennswet. alter. improve, do palish, or repair any structure
prior to its issuance. site requires the applicant for such permit to file a signed cunmem
contractor. lue. Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant I. be provi.ions fir the (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Calc) or
$321840
that he is exempt therefrom Arm the basis fm the alleged eaempfiam Any violation of
APN Number
Occupancy Type
Section 7031.5 by AM applicant for a permit subjects Lha applicant to a civil Penalty of
not mom tion Eve hundred dollars ($500).
Q 1, As owner of Ne property, or my employ= with wages As their sale compensation.
Required Ins actions
will do the wed -and the #"aunl. at Intended of offend for sale (Sao. 70:4, Business
and Professions Code: The Contractor, License law does not apply M an owner of
9 P
property w ho build. fir improves Meana, and who docs such wort himself o titmu{h his
awnemployces, provided that such improvemmtsm mtin¢Med uroffaved Montle If
however, the building or improvement is mid within am yew of completion, the owner.
builder will have the burden of proving Mut he did nm build os Improve fm purpose of
Ne property. am exclusively...actin{ with licensed camraetors to
'metof
sewn tido project (Sec. 7044, and Code:) Tho Congacurs Ll -
wnerBusiness
was Wi red
come law does not apply je ts owner of propeny.who builds of umprom Henan, and
property
who comment for such projects with econuactoHa) licensed pursuantplwafiam
License ate
❑lame: tun Sec ,Bk
AlumerDate9fillOMPENSATIONDECLkRAT10NIbenby
airunder penalty of perjury one of the following
1 haw and will mainuln a CWficato of Cnnmm m AulFlmum fur Workers Compen-
sation, an provided for by Smtion 3700 of the Labor Code. for Ne performance of the
work for which this permit is Issued.
❑ 1 have and will maintain Worker's Compensation I===, As required by Section
37W of the Inbar Cooke, for use perfarmmm of the wort for which this permit is issued.
My Workers Compensation Insurance canier ad Policy number art:
'
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
finds Auction need not bommpleted if the Permit Is imam hondreddollan($100)
or less.)
I cenify that In the Ferro m e f c wwpprrkk TfyPrr t s permit u issued. I shall not
a
employ any person in my r Mlatbemyn t� Oeworiamscompensation
Laws of California. Dn
Applicant
NOTICE TO APPLI . f. afw a Ceairiau of Exemption, you Mount;becomesubjectto
the a . Compcnsauon provisions of the lance Cade, you mw
' forthwith comply with each PMVWDM AT Lou permit shall be doomed ranked.
CONSTRUCTION LENDING AGENCY
1
I hamby alfvm Ne Oen is agency for the performance of
mnswc. 30
s 7, Civ.
' We work for which this permit b issued (Sec. 309'!. Civ. CJ
Lenders Name
Lender', Address
I I codify Nat 1 have rod thin applic don And men %.I the above im(ore.dm 1.
mrmm I agree to comply with all city and county ordinance, And sate laws misting 10
building eonswNon, and hereby authorize reprrmntslive, of this city to CAW uPnn Ma
J above-mentioned propcny, for Inspection purpose,
(We) agree to save. Indemnity and Itecp hamless the City of Cupeum, against
at expenses which may in my say memo against mid City
inMZ'tuting o('his permit.
I'abllities.jR-TOSTANDS
/
DO
q AND WILL COMPLY WI ALL NON- INT
Issued by: Date
SOURCE R ,p /t
(/
U
v
Re -roofs
Type Of ROOF
Si{name p i oto
HAZARDOUS MATERIALS
utsawa handle
Will the or (more building aaupmt nine m hatNk hanrdaod material
As MRrIW by else CupeNno Munici I Code. Chapter 9.12, utd the Health and Safety
he Cupertino
Section 25532(.)7
All roofs shall be inspected prior to any roofing material being installed.
Yes
If a roof is installed without first obtaining an inspection, I agree to remove
mg acupant lax cyuipmcm or devices which
Will the applicmt fir futons .A'
emu havudous air conumina ss recd by the Bry Ana AI, Quality ManaSCmcnt
all new materials for inspection.
Diafict7
o Yes u
IN ad the hnaMmu mmeriWrequimmenuunderC'luptm6.93oftite"",a-
nuNcalN etyCa@.Seetiwu25503.25333 and25334.1unh ifNe but g
deo at dy nave a unset, that it u my M&POMBiliry to nod the OOMPant the
ngvine ch must Iprom tointuanccoracom o"R
d
Signature of Applicant Date
All roof coverings to be Class "B" or better
0wner aatnod> a to
CITE' OF CUPERTINO
BUILDING DIVISION
BUILDING ADDRESS: 7����a�%
OWNER'S NAME:
BUNKER GREGG C
PHONE:
ARCHITECT/ENGINEER
O p LICENSED CONTRACTOR'S DECLARATION
;UP I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
Z W with Section 7000) u( Division 3 of the Business and Professions Code, and my license is
' < e in full force and effect.
j v=Ni Z License Class Lic. It
F, a Date Contractor
ARCHITECTS DECLARATION
7 C < I understand my plans shall be used as public records
)yU
o y Licensed Professional
H OWNER -BUILDER DECLARATION
a g 1 hereby affirm that 1 am exempt from the CoNrst_or's License Law for the
n O following reason. (Section 7031.5, Business and Professions Code: Any city or county
(i 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
"s 2 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
K (- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
i 3 •• 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
not more than five hundred dollars ($500).
❑ 1, 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
and Professions Code: The Contractor's License Law does not apply to an owner of
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,
hoever, the building or improvement is sold within one year of completion, the owner-
bueder will have the burden of proving that he did not build or improve for purpose of
K] 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law �oes not apply to an owner of property -who builds or improves thereon, and
who contracts o itch projects with a contractor(s) licensed pursuant to the Contractor's-
Liccnsc Law. t 1
❑ 1 am eze p Eund Sec. , B & P C forthi`sJreason
Owner ,f Date G
f/
`\WOj R'S CO E-NS'ATION DECLARATIO /1
1 hercb of mi a "penalty of perjury one of the following declarations:
❑ I 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 Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less)
I certify that in the pe (ormance of tb ork rwh'ch Ni 'per it 's issued, I shall not
employ any person in t Y manner so to torr -n, th Yrs'Compensation
Laws of California. telt
Applicant It
NOTICE TO APPLIC a c aking-owf4eatr-of Exemption, you should
become suhject to the rkr.�'s mpensation provisions of the Labor Code, you must
Z forthwith comply with sit h/provisions or this permit shall be deemed revoked.
0
CONSTRUCTION LENDING AGENCY
[-+ 1 hereby affirm that there is a construction lending agency for the performance of
{Yi the work for which this permit is issued (Sec. 3097, Civ. C.)
Lia Q Lender's Name
a+
z Lender's Address
�
U Q 1 certify that I have read this application and state that the above information is
LG correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
aahove-me tinned property for inspection purposes.
( c) agree to save, indemnify and keep harmless the City or Cupertino against
liabilities judgments, costs and expenses which may in any way accrue against said ty
U z in conse PPLIC(((cilTTTeec'oII1If the granting of this permit.
r.
SO RC J2j;��Jt IONS. AND WILL COMPLY ALL NON -P �s
Si nature f Ilea UC�a or Dater
B P
AZARDO ATERIALSDISCLOSURE
Will re pplicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni ipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Ycs o
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
❑Ycs Nu
PERMIT No. 05030120
PERMIT ISSUE DATE
02/23/2606
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
CONDO -3 STORY (2,6821 LIVING)
NEW ADDR WILL BE ASSIGN ON WILDFLOWER WAY
Sq. Ft. Floor Area Valuation
$321840
APN Number Occupancy Type
366±9e7i Au UP Required Inspections
Issued by:
Re -roofs
Type of Roof
Date 7 — 2�3 e,, arm
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
I have read the hamrdous materials requirements under Cha (cr6.95ofthcCal(for-
Znia H a1 & Safety Cod , Sections 25505.25533 and 25534. I undcriand that if the bui�ding
t -unmmly have tenant, that it is my responsibility)e nqq ty the a;cupanl lie/
icy rc tr h7e mus mot.pri r to issuance of a Ccrufr,3tolo u Y.
�71 1 `j ,\, Signature of Applicant
Date
All roof coverings to be Class "B" or better