B-2018-0861 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0861
18880 PENDERGAST AVE CUPERTINO,CA 95014-3621(375 33 044) BILL HAMILTON
ROOFING INC
CAMPBELL,CA 95008
OWNER'SNAME: DATE ISSUED:05/18/2018
OWNER'S PHONE: PHONE NO:(408)379.1303
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=39 Lie.#51
Contractor BILL HAMILTON ROOFING INC Date 04130/2020 X BLDG—ELECT—PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Profeseiots Code and that my
license is in full force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR OFF;INSTALL COMP SHINGLES-(27 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
t. t have and will maintain a certificate o£consent to self-insme for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued.
x.
[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:$11000.00
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 375 33 044
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 th C,iperti unit'al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/18/2018 Issued by:Jasmine Archbold
Date:05/18/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt IYom the Conh actor's License Law for one at the Ra:ROOFS:
following two reacamsoAll roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,of my employees with wages as their sale installed without first obtaining an inspeathu,,I agree t i Hove all new materials for
compensation,will do the work,and the structure is not intended or offered for inSp@ tion.
sale(See 7044,Business&Professions Code) -�
z. I,asowner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:05/18/2018
1 hereby affirm under penalty of perjury one a]the following three decimations: ALL ROOF COVERINGS TO BE CLASS"A"Oil BETTER
r. I have and will maintain a Certificate of Consent to seif-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,far the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the 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 n r—in an to become subject to the material.Additionally,should 1 use equipment at-devices which emit hazardous
p y a y pe y manner so as 1 air cents Inomus as defined by the Bay Area Air Quality Management District 1
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,l become subject to the Worker's Compensation provisions of the the Health&Safely Code,5/ tions 2 605,25533 an 125534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Data:05/18/2018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDI C
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.)
toenter 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 aald 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'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05/18/2018 Professional