07100068 CITY OF CUPERTINO ` ' '
BUILDING DIVISION PERMIT �fi1�Rti�+�� ��������
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BUILDING ADDRESS: PERMIT NO.
10260 TULA LN GODMI�N S CONSTRUCTION 07100068 .
OW NER'S NAME: PERMTI' LS6UE DATE
HOFFMAN JENAY A AND JAMES C PO BOX 8017 � 11/21/2007
PHONE: SANI'I'ARY NO. CONTROL NO.
(530) ��10-8583
tCHI7ECT/ENGiNEER: BUILDING PERMITINFO
HLDG ELECT PLUMH MECH
� � � �
y o p LICENSED CONfRAGTOR'S DECLARATION
� 1 hcrcby �cm that I sm liccnscd undcr provisions oC Chaptcr 9(commencing Job Description
�z �'���cuon7000)ofDivision3ofthcBusincssandProfcssiunsCodc ADD WAI�LS & ROOF ABV EXSTNG STAIRWELL OUTSIDE
�� y in full force and effect
��? Licensc Class [.ic. x ENTRNC TO BA S EMENT
� �,,, p Daic Conusctnr
ARCHI7ECI'S DECLARATION
��� 1 undcrstanJ my plans shatl 6c used as public recorda
e.
L O y Licensed Prufcssional
n, � OWNER-BUILDER DECLARATION
� i� I hcrcby alTirm �hat I am raccmpt from ihc Con�ranor's Liccnsc Law Cor thc
p O following rcason. (SccUon 7031.5, Busincss and Profcssions Cafc: Any city or caunty
K,°, �i which ccqui[cs s pcmiit to conswct, altcr, improvc, dcmnlish, or icpair any swcw�c
y Z� prior W ils issuancc, alsu tcquircs �hc applicam for such permit io filc a signcd sialcmenl
< that he is licensed pursuant to the provisions oC Uic ConvacWr's License Law (CTapter 9 Sq. Ft. Floor Area Valuation
Y t = -� �(commcncing wi�h Scction 7000) of Division 3 af Ihc Busincss and Profcssions Codc) ur $ 6 4 4 8
y�� ihat he is exempt thercfrom and ihe basis Cor the stleged exemption. Any violaUun of
SecGon 7031.5 by any applicant tor a permit subjecu �he applicant to a civil penalty o( Number Oeeupancy Type
not more �hw five 6undicd dollars (5500� 3 5 9131( i 4��
� I, u owner o[ ttie property, ar my cmployces with wages az the'v solc wmpensadon,
will do ihe wark and ihc s�uctum is not inten�d or ofCered for salc (Sec. 7044, Business Re uired Ins ections
and Professions Code: The Conuacmr's License Law daes not appiy w an awner of 9 P
pmperty who builds or improves thereon, and who das such work himulf ar ihrough hia
own emplayces, provided tha� such improvemrnts are not imm�ded or oRercd (a sala ff.
however, �he building or improvement is sold within om year o( complcGon, the owna-
buildu wiR have ihe b�uden o[ proving ihat he did noi build ar improvc for purpose of
sak.). ..
�as owner of die propeny. am wectusively conuacting wilh liansed rnnuactors W
conswct the project (Sec. 7044. Business and ProCessions Code:) The Contracmr's Li-
cense Law does oot apply w an ownv of property wha builds or improves theieon, and ,
who comracis Cor such pmjects with a conuxtar(s) licensed pursuant to �he Convacrors
License Law.
❑ I sm mpt under Sec. , B 8 P C for this rcason
oW �� I 1'!f/� �l'jlll�lv' o .,� fl - , 7 i� • G'
W R ER'S C P ATION DECLARATION
1 hereby sflimi under penalty ot pery'ury one af the fallowing declarations:
❑ I hsve and witl mainuin a Cenificate of Consent lo self-insure for Workcr's Compen-
�tion, u providcd for by Section 3700 of �he Iabor Code. [rn the pedormance of thc
irk for which lhis permit is issued.
❑ I have and will maintain Workcrs Compensation lnsurana, u �equited by Scction
3700 of U�e Labor Code. for �hc pc�formurcc o( the work for which ihis permit is issued. .
My Worker's CompenaaGon Insurana carticr and Policy number a�c:
Cartier. Policy No.:
CER'i1F7CATE OF EXEMPI'ION FROM WORKERS'
COMPENSATION INSURANCE •
(This section Med not be canple�ed it ihe permit is for onc hundred dollars (S 100)
or Icss.) .
f anify ihat in thc perfomiancc of thc work for which ihis permii is iscucd, l shall not
employ any pceson in any mannc� so u to betomc �w Ihe Workcrs' Compcnsation
Laws of Califom L �-' 21
Applicant +.! i� i� Q-$ � � � a/'L
N077CE 7'O APPC.ICA�f, aticr making this CcniCca�e of Fncmption, you shoulJ
become subject to thc Worlccr's Compensation provisions af �hc Latwr Codc, you muu
� O fonhwith comply with such proviaions or this peanil shail be dccmcd revokcd.
z �"'� CONSTRUGTION LEND[NG AGENCY
[— � I hc�cby atTirm ihat thcrc is a consuucGnn Icnding agc�y Cor thc perfortnance uf
pi � We wurk (or which this permit is istued (Scc. J097, Civ. CJ '
W A Lendcr's Name .
� z Lcnder's Addmss
() 0 I certifY ihu 1 have cead this applicuion and state Ihat �he abow info�malion ia
� ►-� cortcc� I sgrce w comply wiih all city md county oNinances md auie Iaws mlating w
0 U buildinb consuuction, and hereby authoria representaGvcs of ihis ci�y to cnter upon p�e
� W alwve-mentioned property (ar inspec�ion purpoxs.
�y (We) agree to save, indcmnify and keep harmless ihe Ciry of Cupertino against
�� liabilitiu, judgmcnls,costs and expenses which may in any way acccuc against said City
V z in canaequence of the granting of �his permi4
�"� APPLICAM' UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by Date � Z� -
SOURCE RECULATIONS.
// � / - G� �
Re-roofs `���
Si uro otApQlian onuacwr Da�c
HAZARDOU ATERIALSDISCLOSURE Type of Roof
Wip ihe applicant or futurc building oaupan� storc or handlc ha•rydous matcrial
az defined by Ihe Cupenino Municipal Codc. Chap�cr 9.12, and thc Hcallh and Safety
c� Section 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs [�140
Will the a�licant or future buiiding occupant use cyuipment or dcvices which If a roof i; � installed without first obtaining an inspection, I agree to remove
cmit ha•rardaus air conuminanu u dcfincd by lhe Bay Area Air Quality Managcmcn� all new m aterials for inspection.
'�isuict?
❑Y� �
1 havc rcad �he hasardews ma�crials rcqui�cmcn�s undcr Ctwp�er 6.95 of ihc Calitor-
nia Ficalth & Safcty Codc, Secuons 25505, 25533 and 25534.1 undcrs�vtd Uia� i[ ihc building
docs not currcntly havc a tcnan4 ihat it is my maponsibitity W noufy ihc occupant nf ihc
rcyuircmcnu which must bc mel pcior to i �� or e c�r�a� or o�NP��. S ignature of Applicant Date
• //-1/-0�'
oW��� o� ori�ed agcnt p„� All roof coverings to be Class "B" or better