B-2018-0776 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0776
22034 CLEARWOOD CT CUPERTINO,CA 95014-1102(326 18 034) EASTMAN ROOFING
&WATERPROOFING
INC
SAN JOSE,CA 95126
OWNER'S NAME: DATE ISSUED:05/07/2018
OWNER'S PHONE: PHONE NO:(408)971-9000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#525051
Contractor EASTMAN ROOFING&WATERPROOFING INC Date 02/29/2020 X BLDG—ELECT—PLUMB
I hereby affirm that 1 am licensed render 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 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:
r. 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 ofthe work for which this permit is issued.
{ zf. yhave 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 Arca: Valuation:$10194.00
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 326 18 034
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 regulati ns per the C_upe/rtinc Mun pal code,section 9.18. ]80 DAYS FROM LAST CALLED INSPECTION.
Signature '' Date 05-07-2018 Issued by:Kim Dunbar
Date:05/07/2018
OWNER-BUILDER DECLARATION
1ereby affirm that f am exempt f1-am the Contractor's License Law for one of the RE-ROOFS:
following hro reasons: All roofs shall be inspected prior to any rooting material being installed.If a roof is
r. I,as owner ofthe property,or my employees with wages as their sole installed without firstoblaii ing an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05-07-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent toself-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthework 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 Cnlifornin Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and rhe
a. I certify that in the performance of the work for which this petnsit is issued,1 Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subjectr'to the material.Additionally,should 1 use equipment or devices which emit hazardous
an-contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califoamin,If,after making this acrtificate of wilmaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the fhe Health&Safety Code\\t\ons 25505, 11531,
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CER'1'IFICA'I'!ON Date:05-07-2018
I certify that I have read this application and slate 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 cf the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCIIIZ S DEA
CI RATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLi
Date 05-07-2018 censed
Professional