B-2017-1839 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1839
10601 E ESTATES DR CUPERTINO,CA 95014-4507(369 25 016) VARGAS
CONSTRUCTION
BRENTWOOD,CA
94513
OWNER'S NAME: CHOKSHI JAYESH AAND'JANKI J DATE ISSUED: 10/27/2017
OWNER'S PHONE: PHONE NO:(925)437-9468
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#589216
Contractor VARGAS CONSTRUCTION Date 02/28/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. , JOB DESCRIPTION:
REROOF;TEAR OFF;COMP SHINGLES(11 SQ)
I hereby affirm under penalty of perjury one of the following two declarations: OATES ROOFING TO PERFORM WORK
1. 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 •
'ormance of the work for which this permit is issued.
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
permit is issued. Sq.Ft Floor Area: Valuation:$7000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 25 016
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue.againstsaid City in c. ' equence of the granting of this permit. •
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant under".,nds 6,,nd will comply with all non-point
source regulations per the f. .-r mo Munici. de, S- on 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
gnature / — 0 i I Issued by:Abby Ayende
Date: 10/27/2017 •
11101
OWNER-:UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-R00_S�
following two reasons: All roofs.shall be inspected prior to any ro.' material being installed.If a roof is
i. I,as owner of the property,or my employees with wages as their sole installed without'first obtaining an ins•. ,/I agree to ove all new materials for
compensation,will do the work,and the structure is not intended or offered for
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the-Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Cod• c hapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I sto •o handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally,should I use equipment or dev,Y a which emit hazardous
air contaminants as defined by the Bay Area Air I u; t Management District I
Worker's,Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino tn' 1 Co.• Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio•/551/. 5 . ,
Labor Code,I must forthwith comply with such provisions or this permit shall
�
be deemed revoked. wner or authorized agent:
APPLICANT CERTIFICATION 4.ate:10/27/2017
I certify that I,have:read this application and state that the above information isCONSTRUCTION LENDIN ► Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction len.O . -.ency for the performance
relating to building,construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3197,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
• to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all,non-point souice regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18., i I understand my plans shall be used as public records.
Licensed
Signature Date 10/27/2017
Professional