B-2018-0855 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0855
21630 EDWARD WAY CUPERTINO,CA 95014-4786(356 18 012) HAMILTON BUILDERS
INC
SAN JOSE,CA 95127
OWNER'SNAME: DATE ISSUED:05/172018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5 Lie.#998293
Contractor HAMILTON BUILDERS INC Dale 10/31/2018 X BLDG—ELECT—PLUMB
1 herebyform that I am licensed under the provisions of Chapter 9 n —MECH X RESIDENTIAL_COMMERCIAL
a p p (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;LIGHT WEIGHT TILE(33 SQ)-
1 hereby affirm under penalty of peiJury one of the following two declarations: (CONTRACTOR TO PROVIDE SPECS FOR ROOF TILE)
t. I have and will maintain a certificate of consent to self-insure for Worker's
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for Nie potforinatiec of the work for which this
permit is issued. Sq,Ft Floor Are.,: Valuation:$25000.00
APPLICANT CERTIFICATION
I certify that I have read tits 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 356 18 012
representatives of this city to enter upon the above mentioned properly 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 understa sand will comply with all non-point
source regulations pert up rf o Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5-17-2018 Issued by:Kim Dunbar
Date:05/17/2018
O NER-B L/DF, DECLARATION
[hereby ER-B,";
drat I aur exempt train the Contractor's License Law not one of the RE-ROOFS:
following twn reasons: All root's shall be inspected prior to any roofing material being installed.His mat'is
r. 1,as owner ofthe property,or my employees with.wages as their sole installed without first obtaining en ins�ction,I agree w remove all new materials for
compensation,will do the work,and the structure is not intended or offered for
sale(Sce.7044,Business&Professions Code)
z I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Cade), Date:55-17-2018
1 hereby affirm under penalty of perjury one of the fullowing three declarations: At 1,12 F VEIiINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. f 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 thisCalifornia 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
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)should 1 stare or hurdle hreandous
shall not employ any person in any manner so as to become subject to the mrcomb; 1nards its dely,should 1 ase ay Area Aint r
devices which emit District
I
conintinao pldented h the Bay Area Air Quality Management 12I
Worker's Compensation laws of California.If,after making this certificate of rill maintain compliance with the Cuper� l,
idpnl Code,Chnp[er 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sect25533,.nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:5-17-2018
I certify that I have read this application and state that the above information isON'TR I - DING AGEN Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is�cp stn.Eion lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per(rAt 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,
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 ARCM I'EC'f'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 5-17-2018 Professional