BLD-2020-1583BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10171 LOCKWOOD DR Cupertino
APN: 342 14 032
PERMIT NO: BLD-2020-1583
OWNER'S NAME: O'MEARA MICHAEL G AND MAUREEN A
OWNER'S PHONE: Not Provided
CONTRACTOR: JERSON ROOFING INC, 1765 LANDESS AVE 155 MILPITAS
CONTRACTOR PHONE:
DATE ISSUED 9/29/2020 7:37:48 AM
ISSUED BY:
VALUATION: $19000
JOB DESCRIPTION
-ply white color 27 sq
remove existing roof tar&gravel install new roofing material TPO single
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: JERSON ROOFING INC
LICENSED CLASS: C39 ROOFING, B GENERAL BUILDING CONTRACTOR
LICENSED NO: 1046769
EXP DATE: 1 1 /30/2020
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 declarations:
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, as
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 this
that I have the option of filing a paper copy of this application
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
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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
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
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issued.
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Compensation
comply
I understand
understand