BLD-2025-0664_SignedPermit.pdf ITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10300 TORRE AVE ApN: 369 31033
PERMIT NO: BLD-2025-0664
OWNER'S NAME: CUPERTINO CITY OF
OWNER'S PHONE:
CONTRACTOR: OWNER -BUILDER
CONTRACTOR PHONE:
DATE ISSUED: Mar 18, 2025 ISSUED BY: Preeti Gupta VALUATION: 0
JOB DESCRIPTION: testing re roof
OWNER -BUILDER DECLARATION:
reasons:
will do the work, and the structure is not
to construct the project (Sec.7044, Business &
as provided for by Section 3700 of the
I hereby affirm
I hereby affirm
that I am
exempt from the Contractor's License Law for one of the following two
owner of the property, or my employees with wages as their role compensation,
or offered for sale (Sec. 7044, Business & Professions Code).
I, as
intended
RII, as
owner of the property, am exclusively contracting with licensed contractors
Code).
of perjury one of the following three declarations:
and will maintain a Certificate of Consent to self -insure for Worker's Compensation,
Code, for the performance of the work for which this permit is issued.
Profession
under penalty
I have
Labor
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
I have
and will maintain Worker's Compensation Insurance, as provided for by
of the work for which this permit is issued.
that in the performance of the work for which this permit is issued, I shall
subject to the Worker's Compensation laws of California. If, after making
Worker's Compensation provisions of the Labor Code, 1 must forthwith comply
revoked.
performance
M I certify
become
the
deemed
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
read the hazardous
maintain compliance
hazardous
Management
25505, 25533,
materials requirements under Chapter 6.95 of the California Health
M I have
will
handle
Air Quality
Sections
with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
material. Additionally, should I use equipment or devices which emit hazardous
District I will maintain compliance with the Cupertino Municipal Code,
and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
QAn EPA Lead -Safe
Certified Firm Name:
k.7)No EPA Lead -Safe
Certified Renovator will be responsible for this project.
Firm Certification
Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm
(Section 8172,
0
Lender's
under penalty of perjury that there is a construction lending agency for the performance
Civil Code).
Yes 0 No
Name: Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may accrue
and will comply with all non -point source
I certify that
laws relating
purposes.
against said
regulations
Signature
I have read this application and state that the above information is correct. I agree to comply
to building construction, and hereby authorize representatives of this city to enter upon
(We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
City in consequence of the granting of this permit. Additionally, the applicant understands
per the Cupertino Municipal Code, Section 9.18.
Date Mar 18, 2025
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 12 MONTHS AFTER ITS ISSUANCE,
OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12 MONTHS AFTER THE TIME THE WORK IS
COMMENCED.