07090162 CITE'OF CUPERTINO
BUILDING DIVISION PER � C} ATIaN*
MIT
PERMIT No.
BUILI�II6V'f�J l 115 ULA LA TBD — TO BE DETERMINED 07090162
l�J G(� PERMIT L59UE DATE
OWNER'S NAME:
HOFFMAN JENAY A AND JAMES C 1 09/24/2007
SANITARY NO. CONTROL NO.
iNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
00
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U
m with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE EX S TNG WINDOWS,LIKE 4 LIKE, W/GLAZING.
'.may L eneClassdeffect. Lie# GODMAN' S CONSTRUCTION NEW BSL PD W PERMIT
t�? License Class
t-C Dam Contractor
ARCHITECTS DECLARATION
i a a I understand my plans shall he used as public records
>yU
LL y Licensed Professional
a OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
ja o following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve.dcmolLsh,or repair any structure
-r^ prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
3 .Ft.Floor Area $8400
?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 9
H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 3 5 91310-1 Number Occupancy Type
not more than five hundred dollars(5500).
0 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 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 does such work himself or through his
own employees,provided that such improvements are not intended or offered for saki.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
sa
te
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contmtoes Li-
ccnse Law does 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 Contractor's
License
❑[ empt under Sea 'BA
P C f this n
Own Date - -
R EWS C N DECLARATION
hereby affimn under penally of pequry one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 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:
Carrier: 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 which this permit is issued.1 shall not
employ any person in any manner to come bject W kers' pensation
Laws of Califo ' D 7
Applicant
NOTICE TO AP CANT:1,a r making th' rtirrcatc of Exemption,you should
become subjecti the Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z OCONSTRUCTION LENDING AGENCY
�~-t ham+ I hereby affirm that there is a construction lending agency for the performance of
(Y, the work for which this permit is issued(Set:.3097,Civ.C.)
W Q Lender's Name
.7 Z Lcnder's Address
U 0 1 certify that I have read this application and state that the above information is
II. correct.I agree to comply with all city and county ordinances and state laws relating to
Jbuilding construction,and hereby authome representatives of this city to enter upon the
U above-mentioned 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 any way accrue against said City
J Z in consequence of the granting of this permit. Date
h-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- DINT Issued by:
SOW@tE REGULATIONS. /
9 Re-roofs
Stof App artt/Comtractor 're T e Of RoofHAZARDOUSZ14UALS DISCLOSURE yP
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 Safely
Code,section M532(a)? —/ All roofs shall be inspected prior to any roofing material being installed.
0 Yes aK.
Will the applicant or future building occupant use equipment or devices which
If a roof:s installed without first obtaining an inspection,.I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Yes CON.
1 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 Ute building
does not currently have a tenant,that it is my responsibility to notify the occupant of thc
requirements which must be met r u ofa Ccrtiftca mf occ Signature of Applicant Date
All roof coverings to be Class"B or better
Own r r authonzed agent are