B-2018-0553 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0553
10378 NORMANDY CT CUPERTINO,CA 95014-3109(369 29 026) LUNNEBORG
ROOFING INC
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:04/04/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#879725
Contractor LUNNEBORG ROOFING INC Date 04/30/2020 X BLDG—ELECT—PLUMB
1 hereby affirm that 1 am licensed 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 full farce and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;METAL(20 SQ)
1 hereby affirm under penalty of perjury one of the following five declarations:
r. I 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
park,mance of the work for which this permit is issued,
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.IT Floor Area: Valuation:$14000.00
APPI.iCANT 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: Orimpancy-Iype:
and state laws relating to building construction,and hereby authorize 369 29 026
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 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 Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 04-04-2018 Issued by:Kim Dunbar
Date:0 410 4/2 0 1 8
ER-I IL I ECLA
I hereby affirm that I am esJoadrom the Contractor's License Law for one of the RE-ROOFS
]'allowing two reasons: All roofs shall be inspected prior to any roofing material being installed,Ira rouf is
r. I,as owner of 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 for
sale(Sec.7044,Business&Professions Cade)
z 1,as owner of the property,am exclusively contracting with licensed Signatureof Appliard,
contractors to construct the project(S-7044,Business&Professions Code). Date:04-04-2018
I hereby of iren under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. ..Inlet.compliance with the Cupertino Muueipal Code,Chapter 9,12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cede,Section 255320)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants 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 Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Snfety Cod^:Sections 25505,25 3,sad 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized
correct.i agree to comply with all city and county ordinances and state Taws I hereby affirm that there Is a construction 'ng 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-polnt source regulations per the Cupertino Municipal ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 04-04-2018
Professional