08020098 CTTY OF CUPERTINO //t�P./^� v4. p �°'yg'�
BUILDING DIVISION PERMITuV,V � 1I„,11r QV1\
BUILDING ADDRESS: PERMIT N0.
22230 VARIAN WAY STERGION CONSTRUCTION, INC. 08020098
WNEWS NAME: PERMITISBUEDATE
HOFFMAN STEVE PO BOX 3214 03/11/2008
ONE SANITARY NO. CONTROL NO.
(650) 364-3376
AR CHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
3G6
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby".thea 1 am Ikeneed under provisions of Chapter 9(commencing P
with Section 7")of Division 3 of the Bosine+evk Professions Code,end my license is REVISION, PATIO/DECK STRUCTURAL -ORIG #06090141-NO
I.full fora end effert
3g'z Lkx.CIM, Lm.• NEW PERMIT.
Dau Conlramor
ARCHITECTS DECLARATION
1 uadersund my piano shall be used As public records
� U
ttG Licensed Profahionai
OWNER-BUILDER DECLARATION
ZO s I hereby aRem Net 11. exempt from the Gesso Code:my c Law far the
i.O4 ralnch reason.scomit TD71.3.Business end Pmfeene. h.Orte city Or county
S 3 fLi wish requires n e.earn re creat the albs.rmprow,h ptro l t li repair end structunctrare
primbiu issuance.earn .the lhciviia eenl for suchpnmitmi'ileae Law( aumem
�< NatmmAcinwithSuantmNepmvivisiu3ofthenuinesLLmmclaw(Code)9 Sq.Ft. Floor Area 0 Valuation
(corr3 On the A exempt
Salon 7O00 theof basis
f r the
the Busegad comss mission.
propoon.Any vi Code)or of
On io Is exempt Oerefrom end the hurt it the ailegad eaenep0on Any it Penalty
of
am Am th 1.7 five
hey,applicant for a permit subjecu the Applicant a a civil pendty ofNumber Occupancy Type
nm mart Wo five huadrtd dollen(5700). 32617044 .4F61
❑I.u owner of Nn proputy,army employee with wages u thessole mmpcnsedon,
will do the wady,and theswctum 4=tmmnded oroffemE forsale(See.7014,Business
and Pretenders Cade:The Conthamr's Licmeh Law does rot apply m an awns or Required Inspections
propmy who buildaaimprowa beton.andwM docs such watt hsaselfm through his .
owaemptayers,provided thatsach imprevemens we not intended coffered threats.If.
however,Na building or improvement is sold within ane year of completion,the owner-
builder will have the burden of proving Nat he did Out build or Improve for purpose of
ealeJ.
N 1,As awns of the property w exclusively contracting with licensed mnuamos,to
'onsmut the Project(Sec 7014,Business and Profcealons Cade:)Tie Conuaemr'a Li-
cove law does out apply m an owner of property who builda or improves abemon,and,
who contracts for such projects with a conu mans)licensed parsexnt m gee Conmetars
Lisette law.
❑I.exempt under Seesyf� �t� - B I P C for this rtuoo
vena Aval 1kv ' /4�Dam 3-//"05 -
WORKER'S COMPENSATION DECLARATION
I hoeby affirm under penalty of perjury oro of the follhwing dalaratiorm
❑Ihave and will maintuna Cadi0usm ofConsontafel�-Wort lmWaM1eYs Compete
htien,As provided for by Section 37M of the Labe Cade,for the performance of the
work for which this permit is issued.
❑I law and will mainuM Work es Compensation Insuranm,u requited by Section
3M.f Ote labor Cads,res the perfarmsuceof the wart for which this pannie is Issued
My Worker's CampenWion Insonece curim And Polies number nae:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cfhs section sued notbacomptewd if the permit is feraro hundred dollars($100)
or lms)
I codify Out in the perru mence of the work for which this permit is Issued.I shall Out
ovployanyperhninany mamterso reassume mbJat athe Workers'Compensation
Laws of Califs r Dau��_ J
Appllaam e#rdr�' f�
NOTICE TO APPLICANT:IL after making dot Certi0cate of Exemption,you should
become subject to the Worker's Compensation provisions or the labor Cads.you muss
.,z forthwith comply with each provisions or this pemeit shall be themed meted
7 CONSTRUCTION LENDING AGENCY
F+ IMoney affirm that drum is a conaerectinn lending agency for she perfurmasum of
{Y,? the work rear which the permit Is iumd(Sec.3091,Civ.C) '
0 Landes Nome
Z z Landues Address
U O 1 certify that I haw read this application and auto that the above information s
ID,E mrmtt I agree u=reply with all city and county on in owes end sue laws relating he
0 Wilding construction.And hereby rothmm representative ofthis city m enter upon to
esti ahma-m=dont pmpeny for inspection pungsea
a (We)agues to an,indemnify and trop l arculau Oe City of Cupertino against
w liabilities.judgments.coats and expenses which may In any way amus against hid City
U 7 in canuqumem of the gr=ting of this perms.
e� APPLICANT UNDERSTANDS AND�WiyL COMPLY WITH ALL NON-POINT Issued by: Date J�/�-4
SOUR REG oNs� J%= 5-11-OT Re-roofs
Signmure of ApplicamKoonnttracmr �I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Molding na mpml hart or handle haartlous material
As deMN by On Cupmino Municipal Code.Chapter 9.12 and the Health And Safety
°°`•S`t'un 25732()? All roofs shall be inspected prior to any roofing material being installed.
❑Yea Na
WIII the applicant or future building occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardous Aireonumrruns As Ofl ed by the Bay Are Air Quality Management all new materials for inspection.
Drurict7
❑Yes IN
I have reni the hararthms materials requircmcnts under Chapter Q97 of the Califor-
maHesl"SafetyCade,Sections 27707.25733 uW 25731.1 unemotional Ones ifOe building
dm net currently have•tmmane On It is my mpamiMlity m mti(y the meupent of Ne
requrrcnenu soh_ icIt muuhemetpiarw ii'h.anrao Certilima,oft}Iupannr. / Signature of Applicant rr Date
ownerortAnde�rd agent ��F/� ' , /D/a-m(Tjs All roof coverings to be Class A."or better
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CITY OF CUPERTINO
BUILDING DIVISION PERMIP
BUILDING ADDRESS: PERMIT NO.
22230 VARIAN WAY STERGION CONSTRUCTION, INC . 08020098
OWNER'S NAME: PERMIT ISSUE DATE
HOFFMAN STEVE PO BOX 3214 03/11/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 364-3376
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Ll O p LICENSED CONTRACTOR'S DECLARATION O O O O
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is r
REVISION PAT I O/DECK STRUCTURAL -OR I G #06090141-NO
��w in full force and effect
z License Class Lic.N NEW PERMIT.
t wo Date Contraaar
jARCHITEC'S DECLARATION
n
UI understand my plans shall be used as public records
w Licensed Professional -
y S
OWNER-BUILDER DECLARATION
2< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
1O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m f, which requires a permit to construct,alter.improve,demolish,(it repair any structure
u Z y prior to its issuance,also requires the applicant for such permit to Ole a signed statement
< Lhat he is licensed pursuant io thc provisions of the Conuactur's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
YFZ- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or O
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 �p
not more than five hundred dollars(WAM 32617044-�7 Number Occupancy Type
❑1,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
and Professions Cade:The Contracmr's Lieense Law does ROL apply to an owner of Required Inspections
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-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[f 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade)The Contractor's U.
cense Law dons not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Conuacler's
License Law,
❑1 am exempt under Set- ,B&PP C for this reason
Owner
WORKER'S COMPEN AMON DECLARATION
I hereby affirm under penalty of perjury ane of the following declarations:
❑I have and will maintain a Certificate of Consent to self-inure 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 Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nis section need not be completed if the permit is for one hundred donars(Sion)
or less)
I cenify that in the performance of the work for which this permit's issued I shall not
employ any person in any maumcr se to bacom�bject m the Worked Compensation
Laws of Califom�r}Datq ',Zn`
Applicant .�'J1aL-L4.. 4174daw
NOTICE TO APPLICANT:If after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked
ZCn
CONSTRUCTION LENDING AGENCY
Fr ►-c I hereby affirm that there is a construction lending agency for the performance:of
IY.> the work for which this permit is issued(Sec.3097,Civ.C.)
a 0 Lendces Name
0 z, Lender's Address
V 0 L certify that I have read this application and stale that the above information is
IL "" correct I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
H a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,..,W) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit �—
►� APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date y
SOUR REG TIONS.
"° A' 9� 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
Cade,Betties 25532(a)?
❑Yes �n��y///o All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building occupant use If a roof is installed without first obtainingan ins ection,I agree to remove
pp g p equipment or devices which P
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? IN.
Yes t
1 have read the hazardous materials mquiremerm under Chapter 6.95 of the Califor.
nia Health&Safely Code,Sections25505,25533 and 25534.I understand thin if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
rt:quirementswhichnustlemel erns- issuance af�ccnificalcerQxu�� Signature of Applicant Date
a' All roof coverings to be Class'A 'or better
Owner or authorized agent Dale'