12100185 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7549 NEWCASTLE DR CON"IRACI'OR:WESTSI-IORE ROOFING PERMITNO:12100185
INC
O\VNER'S NAMF-: TAMMARO PAUL J AND ARLENE N 2245-A FORTUNE DR DA'Z'E ISSUED: 10252012
OWNER'S PRONE: 4082424903 SAN,IOSE,CA 95131 'PIIONF NO:(408)694-0060
❑ LICENSED CONIRAC—FOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT rl PLUMB r
License Class Lie,q
DIECII — RESIDENTIAL 0 COMMERCIAL I
Contractor. Date
hereby affirm that I am licerised under the provisions of Chapter 9 •JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOF&INSTALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions COMP
R
Code and that my license is in dull force and effect. ROOF SYSTEM OVER NEW 7/16
hereby affirm under penalty of perjury one of the fnllowing hco 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.FI Floor Area:0 Valuation:$15615
permit is issued.
APDLICA\"r CERTIFICATION APN Number:36617072.00 Occupancy•I}pe:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state 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
osts,a ami
eswhich ayaccthe i a gCupertino idCityinconst nsequenjudgments, WITHIN Igo DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may acerae against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18:
Issued by: Date:
Signature Date '
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm(hat I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior many roofing material being installed..If a roof is
the fallowing Iw'o reasons: installed without first obtaining air 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 sticture is not intended or offered for sale(Sec.7044,
Business&Professions Code) - Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR'BETI'ER
hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURIi.
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 I have rend the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California llealth&Safely Code Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the lleallh&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(n)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bac Area Air Quality Management District I will
I certify that in the performance of the work for which this permit 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 25.505,25533,and 25534.
Compensation Imus of California. If,after making this cenifcate 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
CONSTRUCTION LENDING AGENCY
AI'1'1-IGW'I'CER'I'IFICA'I'ION
I certify that I haveread 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 awl county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ 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 of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI II.1'FC7"S DECLARA'T'ION
with all non-point source regulations per the Cupertino Municipal Code,Sectiam
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional