B-2018-1159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1159
10887 LINDA VISTA DR CUPERTINO,CA 95014-4778(356 06 004) ROOF ROOFING INC
SAN JOSE,CA 95118
OWNER'S NAME:EVULICH ROY TRUSTEE&ET AL DATE ISSUED:07/10/2018
OWNER'S PHONE: PHONE NO:(408)265.9270
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-38 Lic.#687568
Contractor ROOF ROOFING INC Date 07/31/2019 X BLDG—ELECT_PLUMB
I hereby affirm that I am licensed ander 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 OSD;COMP SHINGLES-(25 SQ)
I hereby affirm tinder penalty of perjury one of the following two declarations:
1. 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
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation hommucc,as provided Far by
Section 3700 of the Labor Code,for the performance of the work far which this
permit is issued. Sq.Ft Floor Area: valantian:$11000.00
APPLICANT CERTIFICATION
I cerlify 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 356 06 004
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 regulations per the pe tiho Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signa Date 7-10-2018 Issued by:Kim Dunbar
Date:07/10/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for
sale(Scc.7044,Business&Professions Code)
z. 1,as owner Of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:7-10-2018
I hereby affirm under penalty or perjm•y one of due fallowing three declinations: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
1. I have and wilt niaint ran a Catifr`cate ofCaugm to sell=inswc 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 lusurmce,as provided for by I have read the hazardous materials requirements ander Chapter 6.95 i f tho
Section 3700 of the Labor Code,for the performance of the work£or which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify(hat in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
Worker's Compensation laws of California.If,after making this certificate of contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino iM.�, po
de,CI pter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections e534.
LaborCode,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent
APPLICANT CERTIFICATION Data:7-10-2018
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-poinfso rce regulations per the Cupertino Municipal ABCHI'IECT'S DECLARATION
Code,Section 9.18. �^�- 1 understand my plans shall be used as public records.
signal tl� Date 7-10-2018 Licensed
Profasslonal