B-2018-1200 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1200
DADDARIO ROOFING
CO INC
CAP ITOLA,CA 95010
OWNER'S NAME:Kosolcharoen Charoen And Winnie Tseng Trust DATE ISSUED:07/16/2018
OWNER'S PHONE: PHONE NO:(831)476-9109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=39 Lie.4430739
Contractor DADDARIO ROOFING CO INC Date 10/31/2019 X BLDG—ELECT_PLUMB
I 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 fs fn hall force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;INSTALL 1/2"OSB;INSTALL COMP
1 hereby affirm under penalty of pc,Jury mre of the following five declarations: SHINGLES-(22 SQ)
r. I have and will maintain a certificate of cmiscnt to self-insure for Worker's
Compensation,as provided for by Section 3700 a£the Labor Code,for the
performance of due 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 Code,for the performance ot'the work farwhich this
permit is issued Sq.Ft Fluor Arca: Valuation:$1245090
APPLICANT CERTIFICATION
I certify that I have read this appllcalion 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 362 24 048
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 Cupertino Municipal Code,Section 9,13. 180 DAYS FROM LAST CALLED INSPECTION.
Signature �` Date 07/16/2018 Issued by:Jasmine Archbold
Date:07/16/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of(he ItE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
u 1,as owner of the property,or my employees with wages as their sale installed without first obtaining air inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for mspectiar.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: M�lftw ZVlk✓�
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/16/2018
1 hereby affirm under penalty of perjury one of tire following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
v I have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
per of the work for which this per is issued. HAZARDOUS MATERIALS DISCLOSURE
I, 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 California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued maintain compliance with fire Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit k issued,I Health&Safety Code,Section 25532Qr)should 1 stare or handle hazardous
shall not employ an poison in an to become subject to the mm-rd.Additionally,should 1 ase equipment or devices which emit hazardous
p y y p y manner so as 1 air contaminants as defined by the tiny Area Air Quality Management District 1
Worker's Compensation laws of Colifornia.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such previsions or this permit shall
be deemed revoked.
Owner or authorized agent: LAdDLI vk,lWS
APPLICANT CCI2TIFICAT[ON Date:07/1612018
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 Municipal - ARCI'1'F.CTIS DECLARA'T'ION
Code,Section 9.18. 1 understand my plans shell be used as public records.
Signature Date Q7 Licensed
/1 612 0 1 8
Professional