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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