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B-2017-2191 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2191 21862 LINDY LN CUPERTINO,CA 95014-4813(356 24 018) WINTER ROOFING INC MORGAN HILL,CA 95037 OWNER'S NAME: CHEN JENNIFER AND SMITH MARK DATE ISSUED: 12/21/2017 OWNER'S PHONE. PHONE NO:(408)363-8052 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO. License Class C-39 Lic.#752097 Contractor WINTER ROOFING INC Date 07/31/2018 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 RE-ROOF,TEAR-OFF,INSTALL OSB,COMP SHINGLES-(28 SQ) I hereby affirm under penalty of perjury one of the following two declarations: L I have and will maintai a certificate of consent to self-insure for Worker's Compensation,as provi ed for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2.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 permit is issued. Sq.Ft Floor Area: Valuation:$11760.00 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: i and state laws relating to building construction,and hereby authorize 356 24 018 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 against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cu ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION Signature Date: 12/21/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1, I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection, sale(Sec.7044,Business&Professions Code) /-. 2. I,as owner of the property,am exclusively contracting with licensed 'Signature of Applicant: ---. contractors to construct the project(Sec.7044,Business&Professions Code). \Date 12/21/2017 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 Lhave read the hazardous materials requirements under Chapter 6.95 of the Section 3700 or the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. 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 store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should Luse equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I tnust forthwith comply with such provisions or this permit shall �%,� correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097 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, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 12/21/2017 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2191 21862 LINDY LN CUPERTINO,CA 95014-4813(356 24 018) XANADU CONSTRUCTION INC SARATOGA,CA 95070 OWNER'S NAME:MARK SMITH&JENNIFER CHEN DATE ISSUED:12/21/2017 OWNER'S PHONE: PHONE NO;(408)892-8402 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic.#949373 Contractor XANADU CONSTRUCTION INC Date 06/3012018 X BLDG ELECT_PLUMB I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in fall force unit effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: RE-ROOF;TEAR-OFF;INSTALL OSB;COMP SHINGLES-(28 SQ) r. I have and will maintain a certificate of eonsent to tadf4rsiuc for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the no 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 permit is issued. Sq.Ft Floor Area: Valuation:$11760.00 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 356 24 018 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 WORI{IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulationsperthe Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature ) Date 04-23-2018 Issued by:Jasmine At Date:12/21/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS, following two reasons: All roofs shall be inspected prior to any roofing material being installed.Its roof is r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for ompensation,will do the work,and the structure is not intended at offered for inspection. sale(So'..7044,Business&Profhssions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature ofAppliera t: contractors to construct the project(See.7044,Business&Professions Cade), Date:04-23-2018 1 hereby offirm trader penalty ol'perjury one of the following three dedurations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 1 have and will maintain a Certificate of Conscal 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 Win on's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Clapler 6.95 or the Section 3700 o£the Labor Code,for the performance of the work for which this California health&Safety Cade,Sections 25505,25533,and 25534.1 will permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(x)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the health&Safety Coa25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ���'' be deemed revoked, Owner or authorized agent: APPLICANT CERTIFICATION Date:04-23-2018 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct,I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,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 Iiabllities, 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 source regulations per the Cupertino Municipal ARCHITECT'SDECLARATION Code,Section 9,18. 1 understand my plans shall be used as public records. Signature Date 04-23-2018 Licensed Professional