B-2018-1838 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1838
20120 LAS ONDAS WAY CUPERTINO, CA 95014-3133 (369 30 027) CUPERTINO ROOFING
INC
SAN JOSE, CA 95129
OWNER'S NAME: DATE ISSUED: 10/26/2018
OWNER'S PHONE: PHONE NO: (408) 973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Lic. #565437
Contractor CUPERTINO ROOFING INC Date 03/31/2020 X BLDG — ELECT — PLUMB
I 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 force and effect. JOB DESCRIPTION:
,
I hereby affirm under penalty of perjury one of the followingTEAR OFF (E) SHAKE, INSTALL (N) 7/16" OSBAND INSTALL
two declarations: LIFETIME ASPHALT SHINGLES (3000 SQ FT).
I have and will maintain Worker's Compensation Insurance, 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
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 building construction, and hereby authorize 36930027
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree tb•save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Add itio'hallyt,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source re ulA, ns per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION,
Signature .� Date 10.26.18 Issued by: SEAN HATCH
Date: 10/26/2018
OWNER-BUILDER DECLARATION
I 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 a roof is
1, I, 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 inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10.26.18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERING +� 1�
1. I have and will maintain a Certificate of Consent to self-insure for Worker's S TO BE CLASS A OR BETTER
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
2. 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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued I Health & Safety Code, Section 25532(a) should I store 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 California If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Workers Compensation provisions of the p
the Health & Safety Code;�5�c ions 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall ,,�•'
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: 10.26.18
I certify that I have read this application and state that the, above information is CONSTRUCTION
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 ARCHITEC 'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Licensed
g Date 0. 6 8 Professional