B-2018-0777 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0777
7488 TIPTOE LN CUPERTINO,CA 95014-5819(359 32 055) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129
OWNER'SNAME: DATE ISSUED:05/07/2018
OWNER'S PHONE: PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#565437
Contractor CUPERTINO ROOFING JNG Date 03/31/2020 X BLDG_ELECT_PLUMB
1 hereby affirm that 1 am IicenseA under 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 fall force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:: RE-ROOF;TEAR-OFF;INSTALL OSB;COMP SHINGLES(32 SQ)
r. 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 ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Cade,for the performonee of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$21500.00
ell'PLiCANT 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 35932 055
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 regulationsper the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature � Date 05-07-2018 Issued by:Kim Dunbar
Date:05/07/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lav Ibr one of the RE-ROOFS,
following two reasons: All roofs shall be inspected prior to any ro.Fmg material being installed.Its.of is
r. I,as o erica f the 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£minspection.
sale(Sec.7044,Business&Professions Cade) /
contractors to construct the project(Sec.7044,business&Professions Code), Date 05-07-2018
1 hereby affirm under penalty ofperjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. 1 have and will nrainmin 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. HAZARDOUS MATERIALS DISCLOSURE
z. I haw and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous matertots requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Cade,for the performance of the work for which this Califmmle Health&Safety Code,Sections 25505,25533,and 25534.I will
t is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9,12 sad the
permit Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. 1 certify that in they person in of the work for which this permit is issued,I material.Additionally,should 1 use equipment or devices which emit hazardous
shark not employ any person in any manner so as ebocome subject ti due air contnmiro ds as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compllanee with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&S t}o,S and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall `\Ji
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data: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 MunicipalARC[I ITECT,s DECLARNNON
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05-e7-2018 Licensed
Professional