BLD-2020-0285BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10375 FARALLONE DR Cupertino
APN:
369 31 018
PERMIT NO: BLD-2020-0285
CONTRACTOR:
GRAVITY SHIELD ROOFING, 148 CARLING COURT SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 2/12/2020 11:12:25 AM
ISSUED BY: JARCHBOLD
VALUATION: $24260
JOB DESCRIPTION
COMP SHINGLES (27 SQ)
RE -ROOF; TEAR -OFF; INSTALL
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
GRAVITY
LICENSED
C39
LICENSED
1011946
EXP
03/31/2020
I hereby
force
I hereby
SHIELD ROOFING
CLASS:
ROOFING
NO:
DATE:
affirm that I am
and effect.
affirm under penatiy
I have and will maintain
for which this permit
I have and will maintain
I certify that in the performance
laws of California.
with such provisions
licensed under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
is issued.
Worker's Compensation Insurance,
of the work for which this permit
If, after making this certificate
or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter
as
Sections
for
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
to
costs,
source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read
construction, and hereby
harmless the City of Cupertino
the applicant understands
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.