06070107 (2) CITY QF CUPERTINOW-!
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS: , BUNKER GREGG C PEgMITNO'06070107
1375 S DEANZA BLVD
OWNER'S NAME: PERMIT MITI!DATE
BUNKER GREGG C 07/18/2006
NE:
SANITARY NO. CONTROL NO.
ARCHn ECT,ENGINaER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MIRCH
Too LICENSED CONTRACTORS DECLARATION lob Description
bt I hereby affirm that I am licensed under Presidiums Or Chapter 9(mmmcKinir P
With Section 7000)of Division]of the Business and Professions Coda,and my license is
in full force and effect. Z �S TEMPORARY POWER POLE
�'4G? License Class Lk.N
Dam l ��—Contractor h
I
ARCHITECPS DECLARATION
I understand my Plans shall W used As public words
h
'o Licensed Professional
s OWNER-BUILDER DECLARATION ,
I i I bereby M.Not 1 car exempt from the Comsetoes License Law for tiun
O o following mason.(Section 7131.5,Business and Professions Cc&:Any city or county
f$ which requites a permit to construct.almr.improve,dcmollsh.fir repair any Muctum $300
-Z a prior to its issuance,&[sa requires the appikanl forsuch permit to Rk a signed sideman
; < thea he Is licensed purseanim the Prov(slons of the Commcmra License LAW(Chapter9 Sq.Ft. Floor Area Valuation
9 (commenclet WN Sectmn7000)of Division]ofthe Bushmaaand PmfeuiansCods)m
f`<— Nat W is exempt therefrom and the baser far the alleged exemplfon.Any violation of
Section 7031.5 by aoy applicant for a permit subjects the applicant to a civil penally of r U U Occupancy Type
not mom than Rw hundred dolerm(S500).
1,An owner of Ne property.or my employees wish wages As their mle compennton,
will do ibework-and thomumen A not intended overrated reraaie(Sec.7044,Business Required Inspections
and Profession,Code:The Consumes Lkenm Law does set apply m N owI nsacr of q P
property who builds or Improws dmmon,and who doessuch work himself or through his
awnemploym,provided that such improvements art notintended oroffered finale.If,
however,me building or Improvement U sold within am year of ampkdon,the manes.
builds,will have Um burden of proving that W did hint Wild or Improve for puhpum of
ale.).
❑1.As owner of the Property,am exclusively contracting with Hommod nem mecum;in
construct the project(See.7044.Business and Professions Code:)The Coe nctora LI-
cane Law dust not 40Y an an owner of Property who Wilds or Imp eves thetan,and,
who contacts for such projects with o anmctor(s)licensed pursuant to the Con ria mes
License law.
❑lomeaempturaer See ,BdPCfathismaao
Owner win
WORKER'S COMPENSATION DECLARATION
1 hemhy of m under pemlty of perjury one of to following declarations:
I ham and will maintain a Certificate of Consent to self-mUm fa Warkcrs Compcn-
sedan.As provided for by Section 3700 of dm Labor Code,for tun Performance of the
work for which this Permit is hued. -
❑1 have and will maintain Workers Compemtime Insurance,As required by Section
37W of the Labor Code,for me peRormance of the weak for which this permit is laved
My Workers Cmmpensaloa buusance carrier and Policy number am:
Cartier: (fie CIQ Policy No.: W
CERTIEKEMFITON FROM WORKE S' LACI 11
—
COMPENSATIONINSURANCE
(Ther mini aced rot be compound B the permit Is fororohunmeddellan($100)
fir Ica.l
I cenify that in the performance of the work for which this permit Is issued.I shall not
employ anypemon in any manners,As an become subject to she Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,AMl making this Cer iRaun of Exemption,you should
become subject to the Worker's Compensation provisions of the Taber Code,you most
OZ foMwim comply with such Novisions or this Permit shall W domed Invoked.
Z► CONSTRUCTION LENDING AGENCY
(-e Ihareby AIR.the them Is a anstactinn lending Agency for the pertormamm of
6i> me work for which suis permit Is Issued(Sec.3197,Clv.C.)
QLenders Name
Q z lenders Address;
U Q I certify mar I haw mad this Wpliudm and sum that me abow iMarmadon Is
w F comet.I cites to comply with all city Nd gamy ordinances and state laws miming to
Q U Wilding construction.and hereby authorise mmmenmtiv a of this city to enter upon the
a alwvc-mentioned property for inspection purposes.
(We)agree to sere,indemnify and keep harmless the City of Cupertino against
r/1 liabilities.judgments.COCA and expenses which may N any soy accrus against said City
U Z m cone tucrme of the granting of mA Permit.
.. AP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
UR REGUL n,5. — -
0-2— Re-roofs
Signatursol'AppliciaturContractolis, Dam
HAZARDOUS AIS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle Wardous material
as deRned by the Cupertino Municipal Code.Chapter 9.11,ad she Health and Safety
Code,sauonv531(a)7 All roofs shall be inspected prior to any roofing material being installed.
[]YOC )EN.
Will the applicant or(future Wilding ocapam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havudma air comumianA a dcRacd by the Bay Ams Air Quality Management all new materials for inspection.
�. rict7
❑Yes
1 have read the hmrdoamamtlals,equimmcnis under Chapmr Q95 often Califmr.
mer Hal"SafetyCede,Sectlons15505.15533 and 75534.1 understood thre fthe Wilding
doer armmly a sen the it Is my respmuihiiity m entry dm occupant of the
re I. to is Ipdmrmianuunemncertinamm0.empanex. Signature of Applicant Date
--� 0,7 b-06 All roof coverings to be Class'B"or better
T,or authorized agent Dom
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT #/a � 0/ 6 /^
S A /u D (J D
OWNER'S NAME: PHONE # r(o S
GENERAL CONTRACT , s FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/C gnature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36619071 . 00
DATE ISSUED. . . . . . . : 07/18/2006
RECEIPT # . . . . . . . . . : 35291
REFERENCE ID # . . . : 06070107
SITE ADDRESS . . . . . : 1375 S DEANZA BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BUNKER GREGG C
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DARREL PARROTT
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : BUNKER GREGG C
. ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
*EE ID UNIT . QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------- -- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 205 . 47 0 . 00 205 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 205 .47 VISA
TOTAL RECEIPT 205 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
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� CITY OF CUPERTINO 0�0 101
TEMP 'OWER
SLUPERTINO PERMIT APPLICATION FORM
APN R_ �� I Date: r O
Building Address:(
7 .09
Owner's Name: Phone #:
u.i
Contractor: Phone: License #:
A.; 9 -?vV--� s
Contact: hone: Cupertino Business License#:
W cd P,qkke7E 1100 515%- 12-9 3
Building Permit Info:
Elect
Job Descriptions O`er
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Residential f Commercial ❑
Cost of Project:
= r / -500
Qty. if
A licabl Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING