0602006101
BUILDING DIVISION PERMIT
VAN HOOFF, WALTER
1 hereby affirm that I not licensed under provisions of Chapter 9 (rnmmemmng
with Suction 7000) of Division 3ofthe Butlnnt and Prafosuom Code. and my Iicen is
in full form mus! effect.
Limn Clan Lic.0
Dau CoMamar
ARCHITECT'S DECLARATION
I understand my plans diol he mod as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 thereby starts that I am exempt from the Carmichael License Law for tic
following meson. (Section 7031.5, Business and Professions Code: My city or county
which molulrm a permit m comrtck Who. hnpruw. demWlsh, nr repair any Mau.
prior to its issuama. Mad requires the applicant for such permit m file a signed moment
that he is Hand Innocent to do pmvislam of the Contractor's limn Lw (Chapter 9
(commencing with Section 7000) of Division Sof Use Business and Profession, Code) at
that he u smmpt therefrom ands the basis for W alleged exemption. My violation of
Suction 7031.5 by my applicant for a permit subjects the applicam In A civil penalty of
not more then five hundred do1Wa (5500).
D I, u owner of du pmpeny, m my wploym with wages u ftBwlo mmpemdon,
will do the work, and the structure Is notinunded wonered rossen (Sec. 7044, Business
and Professions Cade: The Conmacme, License Law dm ant apply to an Owner of
own employees, provided ustsuch improvements tee not Intended martereu for We. If,
however, the Wilding or improvement is sold within am you of eemPle an, the owner
builder will have the burden of proving that he did mn Wild or Impfmc for purpose of
ff 1, as owner of du property, am acludwly comMing with licensed comm em, m
mnstmct the project (Sea Tit". Bion sed Profae. Code:) The Conumsoes U -
can Lw dm not apply m an owner of property who builds or improves thereon. and
who contracts for such pmjecu with aaanummr(0 licensed pursuant m the Coruscates
License Law.
❑tomq/e/pl�pt tend/jr/9A(e�j', BkPCfor this myu,on
Owner (N—`L/ s/U( Dau fj-7i�lf�/
I hereby M irm under penury of perjury am of the following declaralWna:
1 have and will munuln aCeNOesuof Conntm self-Inaum far Worlmes[ompen-
nation, as provided fm by Section 37M of the lobos Code, for du performance of the
work for which Nu Permit is issued.
D 1 have and will maintain Wartres Compau adon Insurance u required by Section
37W of the Labor Code. for the performance of that work far which this penult is immd.
My Warmest Compensation Ineurnam airier and Policy number me:
Cartier. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(fats seedon need nut hecomplcum If tin perch Is forme hundred doman ($100)
or loss.)
I certify that in the pmfornama of the woh for which this permit is issued, l shell an.
employ any person In my mamrso as an bcmmajiubject to do Worlsn'Campmenumn
become subject m the Workees Campemadan pmvWons of the lobar Coda, you mW
OQ forthwith comply with such proviilm m this permit she]m demand revoked.
Z tiCONSrBuCnON LENDING AGENCY
'r+ Ihemby air= thou them is a construction lending&gamy for tho performance of
a the wank fur which this Permit is issued (See. 3097. Or. C.)
DW. Q Lenders Name
a z , ad es Address
() 0 1 easily, Nn I haw mad this application and sum ast tho shove Information is
ly F corma- l agree to comply with all City and county Minxes and sum laws relating m
0 U Wilding construction. and hereby mahodm representatives of this eisym enter upon the
ahove-menduned property for inspection putfuses
(Wc) agree to saw, indemnify and Imp humlm the City of Cupertino against
rF.a can liabilides,judgments.cosu mad expenses which may M my way same against said City
U Z In canseque e. of the grmdng of this pemsll.
s..i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will the applicants or Futuro building ocmpantsuue or handle haallom Mmucial
as de0ped by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety
Cade. Sovion I5532ug7
Dy" ON.
Will the applicant or future building Occupant use equipment or devices which
mit humdom air emuminants a defined by the Bay Area Air Quality Management
R M6
I haw mad Ne haamnus maurialsvequimmenu under Chepmr 6.95 of the Califos
Ith8 Safmy Coda Sectim 25505.25533 md25534.I understood thmif the building
i currently haw a unmet, that It is my naparehliby m notify the aceupmt of the
menu which must be met odor-tobsumce of a Cmuncate of Occupancy.
020061
PERMITINFO
Job Description
ADDITION-35891-GARAGE/PORCH 627 SQ.FT.
SANITARY IS SUNNYVALE'S (JURISDICTION
M
Issued by:
Re -roofs
Type of Roof
AN
Required Inspections
Date
NO.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better