B-2019-0689 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0689
22056 RAE LN CUPERTINO,CA 95014-4031(356 07 030) SILVA ROOFING
SAN JOSE,CA 95148
OWNER'S NAME: DATE ISSUED:04/22/2019
OWNER'S PHONE: PHONE NO:(408)590-5623
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#976447
Contractor SILVA ROOFING Date 09/30/2020 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:
RE-ROOF;TEAR-OFF;INSTALL COMP SHINGLES-(26 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfonnance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above APN
information is correct. I agree to comply with all city and county ordinances Number: Occupancy Type:
356
and state laws relating to building construction,and hereby authorize 356 07 030
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 and tands and will comply with all non-point
source regulations
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 agme to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/22/19
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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
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 perfonnance of the work for 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 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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:4/22/19
I certify that I have read this application and state that the above information is CONSTRUCTfOl NDING 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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 4/22/19 Licensed
Professional
t
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING D[V1SION
10300 1ORRE AVENUE CUPERTiiN!O CA 95014-3255
(408) 777-3228 . FAX (408) 777-3333 - building n�cuoertinc.ora
i'XTiI_ °flits CERTIFICATE HAS I3I;.E?'i
CONIPL.I~" E� ), ;�i NI- ND &Fari RNED TO THE B1711- DING QIL ISIt)
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R31 4�, R315, 2016 CBC Sections -420.6 and 907.2.11.2 ;where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family a--nd multi-fanifl'y dwellings shall be provided -,+Tith Smoke Alarms and Carbon
:Monoxide alarms. When The valuation of additions, alterations, or repairs to existing dwelling knits exceeds
$1000.00, CRC Section R314, R315, and CBC Suctions 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA Si' OKE AI_..13i.RM
CO AI_,1`3RIVa �
Outside'of each separate sleeping area in One immediate vicinity of the +� X
bedroom(s) — (Smolfe alarms shall not be located within 3 feet of batl2room door)
X
On every level of a dwelhn, uiiit including basements and habitable attics
within each sleeping roc�sn ( X
i 1
Carbon Monoxide alarms are not required in dwellings which do not contain: `uel-burning appliances and that
do not have an attached garage. Carbort monoxide alarms combined with smoke alarms shall corn wi11
CBC Section 420.6 and shall be approved by the Office of the State Eire 14iarshal.
Power Supply: In dwelling units vtirifn ne. commerchd po,,,LTer supply, alarm(s) may be solely battery operated.
in existing dwelhng units, alarms are per ��itted to be solely battery operated ,there repairs or alterations d
not result in the removal of wall and ceiling finishes or tllere is no access by means of attic, basement ter crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 4%0.6.2. A-t electhcal permit is required for
alarms-ozhich must be connected to the building i ruing.
As owner of the above --referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the rnant°facii-trer`s instructions and in compliance with the California Building
and California Residentia? Codes. The alarms spc r-ified below have been tested and are operational, as of the
date signed below.
Address:
Pernift No
Specie Number of Alarms: n Srioke Alarms: 4'�t Carbon Monoxide Detectors:
i have read and aclraa to comply with the terms and conditions of this statement
Owner {or Owner Agent's' Name:
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contractor Name:
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