B-2018-0175 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-0175
18911 ARATA WAY CUPERTINO,CA 95014-3676(375 12 040) C D ALL ROOFING
SAN JOSE,CA 95127
OWNER'S NAME:DURAN FELIPE AND CARMEN A DATE ISSUED:01/25/2018
OWNER'S PHONE: PHONE NO;(408)998-6605
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#1003820
Contractor C D ALL ROOFING Date 05/31/2019 X BLDG—ELECT_PLUMB
I hereby affirm that I nm licensed under the provisions of Chapter 9(commencing MECII X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 ot'the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
OVERLAY TORCHING-FLAT ROOF(18 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain s certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
p rformonce of the work£or which this permit is issued.
e and will maintain Worker's Compensation Insurance,as provided for by
action 3700 of the Labor Code,for the performance o£the work for which this
J� permit is issued, Sq.Ft Floor Area: Valuation:$7500.00
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 slate laws relating to building construction,and hereby authorize 375 l2 040
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree 4o 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 underst�ifds and will comgjy with all non-point
source regulations per the�u�f no Munlelp'sf fey action 91B. 180 DAYS FROM LAST CALLED INSPECTION..
Signature �`. Date 01-25-2018 Issued by:Kim Dunbar
Date:01/25/2018
Ove i2-B it
I.hereby affirm that I am exempt from.the Conh•actor's License Law for one of the RE-ROOFS:
]'allowing two reasons: All roofs shall he inspected prior to any rooting material being installed.Its roof is
r. I,as owner of die 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)
z. 1,as owner of the property,am exclusively connecting with licensed Signature afAppli..,t:
contractors to construct the project(Sec.7044,Business&Profossions Cade). Date:01-25-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS 1'O BE CLASS"A"OR BETTERr. 1 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
z I have and will maintain Wet ker's Compensation Insurance,as provided for by 1 have rend the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for tire 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 Code,Chapter 9.12 and the
s. I certify that inthe performance of the work for which this permit is issued,I 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 mnterinl.Additionally,should 1 use equipment or devices which emit hazardous
ta
air conminants as defined by the Bay Area Air QualityMatragement District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Muni•Ignl �IC,Cha er 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 255p5 25''33,and,, 34----'--
Labor Code,I must forthwith comply with such provisions or this permit shall /
be decmcd revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:01-25-2018 ! _
I certify that I have read this application and state that the above Information is - - LENDING A C—Y--�
correct,I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction Idnding 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,Clv 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-paint source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9,18. 1 understand my plans shall be used as public records.
Signature Date 01-25-2018 Licensed
Pratesslonal