D-2018-0046 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0046
10648 GASCOIGNE DR CUPERTINO,CA 95014-3844(375 22 019) RODERICK COOPER
DEMOLITION
PALO ALTO,CA 94306
OWNER'S NAME: DATE ISSUED:08/14/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class M Lic.#984437
Contractor RODERICKCOOPER DEMOLITION Date 09/30/2019 —BLDG_ELECT—PLUMB
[hereby affirm that I 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:
DEMO SINGLE FAMILY DWELLING-(1249 SF);DEMO GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (297 SF)
t. 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
_�,pern
for issued.
ance of the work for which this permit is
and will maintain Worker's Compensation Inxmrance,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: Valuation:$20000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon and state that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Oecupuncy'Iype:
and state laws relating to building construction,and hereby authorize 375 22 019
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 labilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORI{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 '� Data 08/14/2018 Issued by:Jasmine Archbold
Date:08/14/2018
OWN
VER DEZARTl
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner of the property,or my employees with wages as their sole installed without tirst obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or Offered for inspection.
sale(Soa7044,Business&Professicns Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicanw
ec ntrectors to construct the project(See.7044,Business&Professions Code). Date:08/14/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO¢E CLASS"A"OR BETTER1. I have and will main ainta 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. 1 have and will maintain Worker's Compensation iusurance,as provided far by I have rend 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.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this pmmft is issued,l Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ bay person in any nnamer so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Buy Area Air Quality Management District I
Worker's Compensation laws of California.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,a5d2.34.
Labor Code,I must forthwith comply with such provisions or this permit shat)
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Date:e¢/14/2018
I certify that I have read this application and state that the above information Is CONSTiTICTIO LE GE Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending age cy fo e performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued.(Sec.3097,Civ
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertlno 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 ARCI11%T'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public or
Signature Date 08/14/2018 Licensed
Professional