06090141 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ry CONCRACTOR INF4RMATI( .. ,
BUILDING ADDRESS: COOL' S CUSTOM PERMITNO.06090141
22230 VARIAN WY
OWNER'S NAME: PERMIT ISSUE DATE
WE:HOFFMAN STEVE 4718 MERIDIAN AVE STE 13 09/18/2006
SANITARY NO. CONTROL NO.
(408) 353-9692
ARCHITECTIENGINEER: BUILDING PERMTr INPO
BO EO PLO MO
!00 LICENSED CONTRACTOR'S DECLARATION Job Description}� I sand y M.that 1 Am licensed under p addans of Chapter 9(commencing
wit Section zo, infull(amandaffea 7IXgB of Division3ofto Busircu dPro am and my licenseb
a 'F`$`� 7� DRYROT REPAIR PATIO . LIKE FOR LIKE 360 '
LicenseClsss Lc.g
Dam Connecter
ARCHITECT'S DECLARATION
I I understand my plana shall be used u public records
C
Licensed Pnafcuional
OWNER-BUILDER DECLARATION
gS 1 harchy aRrm Nal I em exempt farm the Contractors License Law far the
00 following mason.(Section 7031.5,Business and Pmfessioq Code:Any city or county
$P'i which requires a permit to comedcl alter.improve.demaiim,or repair any umature
_tom primer is issuance.hIso residues tM applicant forsuch permit to fik a signed uatemcnt
G thuMisBeensedparsaltolineProvisiamaftheCondermesLicenxlaw(Chapter9 Sq.Ft. Floor Area Valuation
$ (commencing with section 7000)of Division 3 arrive Businc sand Parfesdom tion rty Crude)or $15000
e'3— Nat he b exempt thmermm and arta bub far Ne alleged exemption.Any viandan of P p
Sec7031.5 by aApplicant,for a permit subjects the applicant m a civil Penalty of APN Number Occupancy ry, e
not mom then An hundred dollars(3500).
❑1.An owder of dta pmputy,or my employees with walla as tek rale companado.,
will do arta wart and th<sttrumuto Is hot Intended or offamd ter sak(Sec.7044,Business Required Inspections
and Prodmiaru Cod=The Canmctues License Law does tet apply m an owner of q P
prepeny who builds or i m prava s thercan,and who does such work himself a trough his
awn employees,pmvided that such Impmvemena are,not intended aro@red forsal=If.
however.the building or Improvement is sold within oras year of completion,to swat•
builder will have to human of proving that he did not build a impmve for purpose of
ank.).
❑1.As aevar of the property,am exclusively contracting wild licensed contractors m -
coutrdet the project(Sec.7W.Business and Profassiom Code:)The Conuaem's LL
ecru law does rat Apply man owner of property who builds ar Impmms trader,and
who eonueea far such projects with A eonusemNa)licensed mouser m the C.-mare on
License law.
❑Iameumptunder See ,BBPCratismama
ruse Data
WORKER'S COMPENSATION DECLARATION
1 hereby afnmo under awry of perjury tete of the following droduat me:
❑I ham provoke mai b in a tori 3700 of the Labor
Cattle.
sum far Warkeh cempcm
sedan,r providW rte mi Sector 3700 of to Labor Code.fm the performance of the
work far which Nia permit is issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700 of on,LAW,Cade,far to Performance of the work far which INA permit is Issued.
My WmMes CampevaW to I..charier and Policy number tie:
Carrier.�;d C&C4n0 Policy No.:�
C FlCA FEXEMPfION FRO ORKER '
COMPENSATION INSURANCE
(rd,section dead not ha completed if to Permit is forane hundred dollars(SIM)
or Isis)
I certify tat in to performance of the wank for which ria permit Is issued.I And not
employ any person in any meaner an an m become subject m to Workers Compensation
Lam of California.Data
Applicant
NOTICE TO APPLICANT:If,After making this Certificate of Exemption,you should
become:subject m to Workers Compensator pm,Woas of to labor,Code,you mud
.,O faMwit comply wit such provisions or this permit shall W dermad remkcd.
ry CONSTRUCTION LENDING AGENCY
[r1hamby M.that to.b Acoeswcfrm landingagency far perfurmence or
rrP.
lde work for which tis permit Is Issued(Sae.3097.Cru.C.)
LLandon Name
a z Lcndefs Address
U 1 cenif,that I have mud tis ap,iiotian had seta that to above information la
U. correct.I agree to comply with all city and county on inancq and Aum laws totaling to
0building construction,and hereby Antonin representatives of this city to enter upon to
Uebovcroo.d.red property for inspectionrpose
pus.
uil P. (We)agree to sane,Indemnify and keep harmless tete City of Ceramic agarmt
h livbiliuq,Judgmdena.tqu and gpcges which may in any way sterna agaigl aid City
V7 ktamequer¢af the{mrurg of ria perms. Issued b Date
r� APPLIC UND STAN AND T$TLL NONPOINT y
SOURCE G N �—
Re-roofs
Si{nuu of IieanUC°n ter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
dl apP11—lorlul�� ,.IdC.,:mcupanimm"hAndichvardousmawrW
a def d b the Cupertino Municipal Cade.Chapter 9.11,and to Heal"and Safety
Com, a155311a)7 / All roofs shall be inspected prior to any roofing material being installed.
q U
Will tc applicant or future building=open[use equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazam us air contaminants As dermad by to Bay AMA Air Quality Management all new materials for inspection.
District7
❑Yes Nu
[have toW the haaaatats materials rcquirememt makrChaptaa 6.95of the Glifor-
meHgW&Safcty Com.Sauan 25505,25533 and 75534.1 understand thuifde building
deantat curmntly am a tarn, n ll.a my responsibility m Maury Om oaupant of me,
ream a ..A,be arm °�y A/- Signature of Applicant Date
` at
Ow r Data
All roof coverings to be Class"B"or better
r athorimd age '