07110111 CITY OF CUPERTINOt.+.
A BUILDING DIVISION PERMIT CLINTRAMOIR�INEORMATION.,1
PERMIT NO.
BULT&2r> '6 ULA LN GODMAN' S CONSTRUCTION 07110111
OWNER'S NAME: - - PERMITISSUEDATE
HOFFMAN JENAY A AND JAMES C PO BOX 8017 01/04/2008
IN
NE: SANITARY N0, CONTROL NO.
(530) 510-8583
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION
1 hartby affirm But I am licensed ude
nr provision zf Chapinr 9(ummmcing Job Description
':i with Sation]OW)afDlvitlon3zflW Budmmev and Profesauv Code.and mylkemsmh ADD 12 SQ&90 SQ PRCH, BRK VENEER FRNT HSE, FRNT
6 ce
in full faand effete
°i License Cie. Lite.A PRCH
Dam
ARCHITECTSDECLARATIONEXT,BAY WINDW REPLACE EXST WINDOW
i I undcnunJ my phna shall W used as public raards
:e at;� LicenmJ Prefixed onal
3 OWNER BUILDER DECLARATION
n I hereby.tree on 1 em exempt from Nc Contractors License:Anyc taw for ily
3 Og O9 following mama(Section 7031.5.Business and Pefcssiuv Cale:Any city c county
which requires a permit a cistron,ilter,improve,demoihli lir repair any mrmum
,zi
prior aits issuance,also mquima the applicant far such permita file asigned swament
< Ihithei,licensed pursuant tothe privisionsofthe Contractors Licorice Law(Chapter 9 Sq.Ft. FlodrArea Valuation
(tormenting with Saban 7000)or Division 3 or the Business and Professions Code)or $13200
i $ Lha he h e:emPt therefrom and the bash fa the il1egW eaempton.My violuion of
Sudan 7031.5 by my appllam far a permit subjects the applicant to a civil perat of pp�aT Number Occupancy Type
rat tae Nm five handled dollar(55007. 3 5 913 10 4:17 U'
0 1,As owner of the Property.or my crployees with wages An theirs.a compensation,
will do tin wokand Nennumre is not intended or offered faraalc(Sm.T0a4.Business peRequired Inspections
And Profession"Cade:The Contexture.License law dao rot apply man ower of 9 P
pmnywW Wildsorimpmmthefmn.andwhadassuchworkhimselforthrughhh
own employees,provided that well Improvements are not intended ara@cod fraale If.
however,the Wilding or Improvement is cold within ane year of completion.the owner-
builder will have him burden of proving that he did cot Wild are improve for puryoae of
rte.).
1,as owner of the Property.am exclusively contracting with licensed come acms b
r
c as I the Prjat(Sec.7004.Bwinent and Professions Caere)The Cuatrvmurs Li-
unse law does not apply in an owner of Photons who Wilda or improves thereon.and
whoumtrses far such projects wit A emons arta licensed Puruam in Ne Centralize
Late.law.
❑la hptundn'See ,B&PCf Nis
Ow Dae 1
W S OMP SN DECLARATION
12
mbY aR�under penilty a(perjury aro of tin(zlbwin8 dalarariama
have and will maintain a Certificate of Cansenuo self-invert far WorheraCorran-
n,As provided for by Section 3700 of Ne Labor Cade.for to performance of the
work for which this permit is issued.
❑ I have and will maintain Workee Compevadan Inmsance,As mquirtd by Sedan
37110 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compermin.Imam a carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('this section seed not W completed if the permit is fromm hundred dolW($100)
or leas.)
I celery Out in the performance or the..,it far which thia permit is issued.I bull nm
cmplayany Permninanymmnenoas,tobeepin$J�6b' t ,loon'Compenadon
Lawaof Califpra��99 Lew 6!%- ll,r
Applicant / A� il,i—
NOTICE -0 PGCANT:If,aMr making thi niFimm or Eumpton,you aWuM
haeme subjc In he Workers Compensation prevision of the LAW Code,you muss
,J O forthwith comply with such pmvisiav or Nis pulau shall he deemed revoked.
Z'^' CONSTRUCTION LENDING AGENCY
I hereby ilrum that Vert is a construction lending agency far to performance of
Qi > tho walk far which Nis permit Is insured(Sec.3097,Civ.C.) -
LL1 Lenders Name
z Lender's Add..
V 0 1 eenify that 1 have mad Nis application And sum Nu the above information is
ry conte.1 agree to comply with all city and county eminences and sum laws lehting a
QU building consuuctimh and hereby autborien repremmatives of this city m enter upon the
a above.menWned prpcny ler im,pection purposes.
(Wa)agree to save,indemnify and keep harmless the City of Cupertino again,
F' fn liabilities,judgments,costs and expenses which may in any way aecrec again,said City
CJ Z incovcgmnccofthegrntngofthislurrrit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL�1ON INT Issued by: Date i y ��
S R EREGULA71ONS. / / / I
s61"hor���C�r /—so
�— Re-roofs
HAZARDOUS h RIALS DISCLOSURE Type of Roof
Will the applicant or fuare Wilding oceupanut..or handle hmammts material
As defined by the,Cupertino Municipal Code,Chapter 9.12.and tre Healik orb Safety
Code,Section ly.sss3xa77 �J'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes Mvo
Will the applicant or building Occupant use equipment asdeviats which If a roof is installed without first obtaining an inspection,I agree to remove
it hmardnun air mnmminants As defined by the Bay Area Air Quality Mansgearem all new materials for inspection.
41 net? ('
❑Yes You
1 hent read the hssamtas maariah requirements under Chapter6.95 of t eCalifor.
ria Health&Safety Cadc,Sectors 25505,25533 Md25534.1 urdcrseind thmifthe Wilding
docs mat contently have a want into It is my reapovibility to notl'y thte ant f tin
oxi mantswhichmuRWma 1 Camri tcOfCccu Signature of Applicant Date
t O All roof coverings to be Class"B"or better
Ow'Cr arthorind Agent f9a'