12070166 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 10558 GASCOIGNE DR CONTRACTOR:ALL SEASONS ROOFING S PERMITNO: 12070166
SOLAR
OW'NER'SNANIE: CHING YUN HSIANG 1720SMITUTAVE DA'Z'E ISSUED:07202012
OWNER'S PHONE: 2087611203 SAN JOSE.CA 95112 PHONE NO:(408)9714455
❑ LICENSED CONI'RAM'OR'S DECLARATION BUILDING PERMIT INFO: BLDG [ ELECT r1 PLUMB r
License Class Lic.q
. NIECII r RESIDENTIAL r COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING ROOF:INSTALL NEW 7PO 80MIL
(commencing with Section 7000)of Dkision 3 of the Business S Professions FLAT
Code and that ntv license is in full force and effect. AND TIMBERLLINE HD SLOPED-26 SOFT
I hereby affirm under penalty of perjury one of the fnllowing two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,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 Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Fluor Area:0 Valuation:$17000
permit is issued.
AI'1'LICAY'I'CIsR'1'IFICA'I'ION APN.Number:37523006.00 Occupancy Type:
I certify that I have read this application mid state that the above inlonnation is
correct.I agree to comply with all city and county ordinances and stale laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and
keep harmless the City ofCupertinosaid against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
grunting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulatints per the Cupertino Municipal Code,Section ,
9.18.
Issued by: Date:
Signature Dntc
❑ OWNER-BUILDI'R DECLARATION
RF:ROOFS:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining art inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business S Prolessions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(See.7044,Business R Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury ane of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IL\%\RIlO11S MATFRL\LS DISCLOSURE
Compensation,m provided for by Section 3700 of the Labor Code,for the I hnve read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California Ilcalth S Safety Cude,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,to provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health S
Section 3700 of the Labor Code,for the perfommnce of the work for which this Safety Code.Section 25532(a)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this pennit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505.25533,and 25534.
Compensation Imes of Cali fomia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
AI'I'LIC.\N-I'CFR'I'I FICA'1'IO,N CONST RUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Cir C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City ofCuperino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting ofthis permit.Additionally,the applicant understands and will comply ARCI11TEC'I"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand m)•plans shall be used m public records.
Signature Date Licensed Professional