BLD-2020-0877BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10360 E ESTATES DR Cupertino
APN: 369 14 001
PERMIT NO: BLD-2020-0877
CONTRACTOR:
F F F ROOFING SPECIALIST, 657 GAUNDABERT LANE SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 6/24/2020 9:40:09 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $20000
JOB DESCRIPTION
INSTALL 1/2 " PLYWOOD; INSTALL ASPHALT SHINGLES. - (32 SQ)
RE -ROOF; TEAR -OFF CONCRETE TILES AND DECKING;
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
F F F
LICENSED
C39
LICENSED
850673
EXP
03/31/2021
I hereby
force
I hereby
ROOFING SPECIALIST
CLASS:
ROOFING
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatly of perjury one of the
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall be
following
to self
Insurance,
for which this
this certificate
deemed
three declarations:
-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit 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
revoked.
V
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chatter 9.12
V
with
equipment
Municipal
Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
responsible for this project.
Firm Certification No:
this project.
An EPA Lead -Safe Certified Renovator will be
Firm Name:
No EPA Lead -Safe Certified Firm is required for
Certified
CONSTRUCTION LENDING AGENCY
is a construction 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
No
Lender's
Name:
APPLICATION CERTIFICATION
that the
of this city
non -point
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I
construction,
harmless the
the applicant
Signature:
"
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.