B-2018-1305 CITY OF CUPERTINO BUILDING PERMIT
BUILDINCADDRESS: CONTRACTOR: PERMIT NO:B-2018-1305
21372 MILFORD DR CUPERTINO,CA 95014-1328(326 41 092) CRAFT BUILDERS
CONSTRUCTION
MORGAN HILL,CA
95037
OWNER'S NAME: DATE ISSUED:08/01/2018
OWNER'S PHONE: PHONE NO:(
LICENSED D CONT ACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C10.C39 Lie.#1005138
Contractor CRAFT BUILDERS CONSTRUCTION Date 07/31/2019 X BLDG_ELECT_PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 ofthe Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
.RE-ROOF(PARTIAL);TEAR-OFF;INSTALL 1/2"CDX;INSTALL
I hereby affirm under penally of perjury one of the following I've declarations: COMP SHINGLES-(25 SQ)
t. 1 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
/
have and will maintain Worker's Compensation from ance,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 Area: Volmrtiom$13805.00
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 Occupancy Type:
and slate laws relating to building construction,and hereby authorize 32641 092
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 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 0 810 1/201 8 Issued by:Jasmine Archbold
Data:08/01/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will de the work,and the structure is not intended or offered for
sale(Seo.7044,Busineas&Professions Coda)
z I,as owner ofthe property,am exclusively contracting with licenser) Signature ofApplicane
contractors to coast et the project(Soc.7044,Business&Professions Code). Date:08/01/2018
I hereby affirm under penalty of perjmy one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
u I have and will maintain a Certificate of Consent to setf-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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insumoce,us provided for by I have read the hazardous materials rechdremmtts 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 25534.1 will
permit is issued. maintain compli m n,with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that iu the performance of the work for which this permit is issued,1 Heniti,&Safety Code,Section 25532(0)slmuld I store or handle fou nrdmrs
shall not employ any person in any manner so as to became 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 I
Worker's Compensation laws of Cali rot ria.If,all making this certificate of will maintain contpliaace with the Cupertino Municipal Code,Chapter 9,12 and
exemption,I become subject to the Worker's Compensation provisions of the the Hualth&Safety Code,Sections 2 O5,255 ,slid 25534.
Label Code,I must forthwith comply with such provisions or this permit shalt
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/01/2018
1 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.Additlonally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08/010018 Licensed
Professional