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06020071iU Lt •�w 0. 1=W .nz I w i 1yU , Vl� 3a� :DOn -Zi =FC U CITY OF CUPERTINO BUILDING DIVISION PERNM � y.� i�ta�: 14 A i�1 �J`I► .: BUILDING ADDRESS: PERMIT NO. 06020071 1375 S DE ANZA BLV OWNER'S NAME: PERMIT ISSUE DATE BUNKER GREGG C 02Z23/2006 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full fora and effect. NEW RETAIL SPACE 1825' Lactose Class Lick Date Contractor ADDR ASSIGNED TO 2ND FLR 1377 & 1379 S DE ANZA ARCHTTECSDECLARATION REPLACES EXPIRED PERMIT 04050082 I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter. improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that be is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Cole) or $218470 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). ❑ 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 forsale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended oroffered forsale. If, however, the building or improvement is sold within one year of completion, the owner - buil er will have the burden of proving that he did not build or improve for purpose of ). Wsal I, 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 does not apply to an owner of property -who builds or improve thereon, an who con c for such projec wi co to s) licensed pursuant to Ne ntractor License w. ❑ l am a p u r S B& f this n Owner Da WOR 'S MPENSATI DECLARA following I hereby affirm unde ty of perjury one of the declarations ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers 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 Workers Compensation Insurance carrier and Policy number are: Cartier: 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 performance of the work for v cb Nis permit is issued, 1 shall not employ any n in any manners t come lett to the Workers' Compensation �� Laws of Cali o ' , Da c Applicant NOTICE TO P C ter making Nis c 4catc of Exemption, you should become subject to c Worker ompensadon provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued (Sec. 3097, Civ, C.) Lenders Name , r Lenders Address 1 certify that 1 have read this application and state that the above information is " cortecL 1 agree to comply with all city and county ordinances and state laws relating to " building construction, and hereby authorise representatives of this city to enter upon the ahove-mcndoned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in anyway accrue against said ity � in c sequence of the granting of this permit. " AP CANT UNDERST D hi D W L MPLY WITH ON -P I T Issued by: Date 2- 2 3 a 6 SO EGUL TI 3 CM Re-roofs�f Signa f Appli onuactor Date DOUs MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hasardous material as defined by the Cupertino Muni ipal 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. Dyes o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hasardoos air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disuict? ❑ Yes u 1 have read the hasardous materials requirements undcrChapter 6.95 of the Califor- Pudding ni H IN & Safety Code, Sec ' ns 25505, 25533 and 25534.1 enders d that if the ' d t urrcndy have tc n th 't is my responsibility to nod y the oceu t of dtc qu a s. s pri issuance of a cerrifi a fp ��/hJ Signature of Applicant Date — GG All roof coverings to be Class "B" or better ow rorauthor .c a nl ate *ITY OF CUPERTINO * 6� S Ci7Yor PERMIT APPLICATION FORM CUPERTINO APN W Fee Description Date: 2, ' Bu in Address: 1 Mailing Address (if fferefrom b ilding address): q,wner's Name: BBLDGFEE Bldg Permits . foot ontracto : • w p License #: Contact: Phone: B I— 1 bl Fax: Cupertino Business License#: Buildi - �Permit Info: Bld Elect Ec Plum -� Mech Ill Job Description: Residential ❑ > f l�•— BBOILER4 Sq.Ft. Floor Area: s MECHANICAL BBOILER5 Cost of Project: J 01 Lyn -u MECHANICAL Icupancy Group: Type of ConstructioY/ �y f j Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Large ❑ Jr Major ❑ BCONSTAXBQ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BEWESTIGA Investigation fee I BUILDING 1 of 3