BLD-2020-1524BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19749 MERRITT DR Cupertino
APN: 316 35 010
PERMIT NO: BLD-2020-1524
OWNER'S NAME: VADODKAR RAHULDEO AND BHAGYASHREE
OWNER'S PHONE: Not Provided
CONTRACTOR: JIREH INC, 888 Faulstich Ct san jose
CONTRACTOR PHONE: 4082989399
DATE ISSUED 9/21/2020 11:33:01 AM
ISSUED BY:
VALUATION: $14566
JOB DESCRIPTION
of Composition 29sq
Re -Roof - tear off one layer of shake and install OSB and one layer
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: JIREH INC
LICENSED CLASS: C39 ROOFING, B GENERAL BUILDING CONTRACTOR
LICENSED NO: 800707
EXP DATE: 10/31/2021
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
laws of California. If, after making this certificate
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
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
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