B-2018-0770 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0770
22125 REGNART RD CUPERTINO,CA 95014-4844(366 02 042) DANEL ROOFING INC
SAN MARTIN,CA
95046
OWNER'S NAME: DATE ISSUED:05/07/2018
OWNER'S PHONE: PHONE NO:(408)695-0072
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_39 Lic.4814209
Contractor DANEL ROOFING INC Date 08/31/2018 X BLDG ELECT_PLUMB
I hereby affirm that[am licensed ander the provisions of Chapter 9(commencingMECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Cade and that my
license is in fill]force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF:INSTALL UNDER-LAYMENT;INSTALL COMP
1 hereby affirm under penalty of perjury one of the following two declarations: SHINGLES-(29 SQ)
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance ofthe work for which this
permit is issued. Sq.Ft Floor Area: Villuatimin$16000.00
APPL.TC 'F 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 stale laws relating to building construction,and hereby authorize 36602 042
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 p11 and stands and will comply with all non-point
source re o er the c ertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
ure
Signatjl( Date 05!07/2018 Issued by:Jasmine Archbold
Date:05/07/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the Rh;ROOFS:
following two reasons: All roofs shall be inspected I'll
to any roofin.material being installed.If.roof is
r. 1,as owner ofthe property,or my employees with wages as their sole installed without first ob in g an'nspection, agree to remove all new materials for
compensation,will do the work,and thestructure is not intended or offered for
\
contractors to construct the project(Sec,7044,Business&Professions Code). Date:05/07/2018
I hereby affirm under penalty of perjury one of tine following Bree declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER1. 1 have and will maintain a Certificate of Consent ro self-Ensure for Wce ke"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. 1 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 ofthe 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
3. I certify that in he performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store ur handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equi meat or devices which naft hazard
contaminantsair as delined by it a Bay n Air Qualit nnngement District I
Worker's Compensation laws of California.If,after making this certificate of willmaintain couplirmce with the up tin Mnnicip 1 Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety ode, ec Ian 2551 ,2 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall _
be deemed rrevoked' Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/07/2018
I 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 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 MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05/07/2018 Professional