BLD-2020-1535PermitBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 22344 RIVERSIDE DR Cupertino
APN: 356 02 013
PERMIT NO: BLD-2020-1535
OWNER'S NAME:
OWNER'S PHONE: Not Provided
CONTRACTOR: WILLIAMS - TYLER INC, 1239 WEATHERSFIELD WAY SAN JOSE
CONTRACTOR PHONE: 408-277-0800
DATE ISSUED 9/22/2020 9:47:58 AM
ISSUED BY:
VALUATION: $13650
JOB DESCRIPTION
SHINGLES (2200 SF).
REMOVE (E) SHAKE ROOF; INSTALL OSB; 30 LB FELT; AND SOLARIS COMPOSITION
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: WILLIAMS - TYLER INC
LICENSED CLASS: C39 ROOFING, B GENERAL BUILDING CONTRACTOR
LICENSED NO: 501852
EXP DATE: 10/31/2022
I hereby
force
I hereby
affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
and effect.
affirm under penatiy of perjury one of the following three
I have and will maintain a certificate of consent to self -insure
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which this permit
laws of California. If, after making this certificate of
with such provisions or this permit shall be deemed revoked.
and agree that I am electronically signing and filing
that I have the option of filing a paper copy of this application
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
1
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
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
this application and that checking the box below has the same legal effect as manual signature. I also
with a manual signature but have chosen instead to file this application electronically.
work
2
issued.
3
Compensation
comply
I understand
understand