07080245 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � 'KC} c�� l�r�4 ;
BuIIDl �+2DgEsS: PERMIT NO.
VARIAN WAY HOFFMAN STEVE 07080245
GWNER'SS NAME: PERMIT ISSUE DATE
22230 VARIAN WAY 09/05/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
toe CONTRACTOR'S DECLARATION
0 o m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z. with Section 70DG)of Division 3 of the Business and Professions Code,and my frcense is REVISION TO PERMIT #0 6 0 9 0 14 1 OVERHANG TO BACK
<y in roll force and effect .
? Ucenso Class Lic.M PATIO & PATIO
F q Date Contractor
ARCHITECTS DECLARATION
:� 1 understand my plans shall be used as public records
;W U
LL Licensed Professional
h OWNER-BUILDER DECLARATION
f hereby affirm that 1 am exempt from the Coolmetors License Law for the
cep O following mason-(Section 7031.5,Business and Professions Code:Any city or county
$(ii which requires a permit to consuvct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires tier applicant for such permit to file a sigrhed statemem
=0 drat he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq•Ft.Floor Area Valuation
F in (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 0
_ 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 Number Occupancy Type
not ram tun rive hundred dollars(s500). 3 2 61 7 0 4 4.V ll
❑L 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 Cod*The Contractors License Law does not apply to an owner of �l P
property who builds or improves thereon,and who does such work himself or through his
own employee,provided that such improvements are not intended or offered for sales If,
however,the building or improvement is sold within one year of compleuoa,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner or the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cod*)The Contractors Li-
cone Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with it conusetor(s)licensed pursuant to the Contractors
Lacenae Law.
❑I am t under Sec .B&P C for Ih)s rcasoa
Owner Dale y -6 a
•WORK COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑1 have and will maintain a Certificate of Consent to self-insure for WorkdsCompen-
sarion,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 Workers Competation Insurance,as required by Section ..
3700 of the Labor Code,for the performance of the wort for which this permit is Lssued.
My Workers Compensation Insurance carrier and Polity number are:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be compietcd If the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is Issued.1 shall not
employ any=. in any manner so become su •ect to the Worker{Compensation
Laws of Califon• .
this Certificate of Exemption,you should
become subject to the Woods Compensation provisions of the Labor Codc,you mast
.�Z forthwith comply with such provisions or this permit shall be deemed revoked.
,zh O CONSTRUCTION LENDING AGENCY .
f-+ 1 hereby affirm that there is a construction lending agency for the performance of
fY. the work for which this permit is iisucd(Sec.3097,Civ.C.)
ALendds Name ,
Z Lcadees Address
U Q I certify that I have read this application and sate that the above information is
V. correct_I agree to comply with all city and county ordinances and sate laws relating to
O building construction,and hereby authorim represenativ s of this city to enter upon the
W shore-mentioned property for inspection purposes.
FLl.h (We)agree to save,indemnify and keep harmless the City of Cupertino against
H N liabilities,judgments,costs and expenses which may in anyway accrue against said lily
in consequence of the granting of this permit y.
>~ APPLI WITH NT UNDERSTANDS AND WILL COMPLY W ALL NON-POINT Issued by: Date -J
SOUR REG 1.ATT S.
6- Re-roofs
Signature of Applican ntractor 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.
❑Yes C4t+6
Will 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 hazardous air conraminans as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 0-0—
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
does not cuftily have a is nanL,that it is my responsibility to notify the occupant of the
requiremen issuance of a CcrtGwhc of Occupancy- Signature of Applicant Date
G^ All roof coverings to be Class "B"or better
Owner or auLhorizrd agent Datc