B-2018-1316 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1316
10311 CHERRY TREE LN CUPERTINO,CA 95014-2005(316 33 057) WF,STSHORE
ROOFING INC
SAN JOSE,CA 95131
OWNER'S NAME: DATE ISSUED:08/03/2018
OWNER'S PHONE: PHONE NO:
LICENSED CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#787221
Contractor WESTSHORE ROOFING INC Dale 11/30/2018 X BLDG—ELECT_PLUMB
I hereby affirm that[nm 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 fore,and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;INSTALL COMP SHINGLES-(9 SQ)
1 hereby affirm under penalty of perjury one of the following two decL rations:
I I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided fmby Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
Section 3700 of the Labor Code,for the perfornianoe of the work for which this
permit is issued, Sq.Ft Floor Area: Valuation:$7381.00
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 Type:
and state laws relating to bullding construction,and hereby authorize 31633 057
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 regulat Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature. ( Date 8-3-2018 Issued by:Kim Dunbar
Date:08/03/2018
OWNER-11UII ER DE LARATION .
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If e roof is
1. 1,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
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8-3-2018
I hereby affirm under penalty of perjury one of the following three deal araBarn: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
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 of the Labor Code,for the performance of the work far which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and tlm
s. 1 certify that in the performance of the work for which this permit is issued,J Health&Safety Code,Section 25532(a)should I stare 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 I
Worker's Compensation laws of Califorcia.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety
)
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Dale 8.3-2018 Licensed —
Professional