BLD-2021-1127BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 22240 HOMESTEAD RD Cupertino
APN: 326 51 004
PERMIT NO: BLD-2021-1127
OWNER'S NAME:
OWNER'S PHONE: Not Provided
CONTRACTOR: I Q V CONSTRUCTION & ROOFING, 877 CHESTNUT STREET SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 6/15/2021 12:02:52 PM
ISSUED BY: haleym
VALUATION: $26667
JOB DESCRIPTION
Remove existing BUR Roof, Install Carlisle 50 mil PVC over tapered system (18.5 sq)
BUILDING A - 22240 & 22250 -Re-Roof
LICENSED CONTRACTOR DECLARATION
the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
07/31/2021
I hereby
force
I hereby
I Q V CONSTRUCTION & ROOFING
CLASS:
BUILDING CONTRACTOR, C39 ROOFING
NO: 963219
DATE:
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of
laws of California. If, after
with such provisions or this permit
one of the following three
of consent to self -insure
Insurance, as
the work for which this permit
making this certificate of
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
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under Chapter
9.12 and the Health
as defined
Sections
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
V
CONSTRUCTION LENDING AGENCY
that there 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
application
representatives
against liabilities,
will comply
and state that the above
of this city to
judgements, costs,
with all non -point source
enter
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
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
construction,
harmless
the
Signature:
that I
the
applicant
have read this
and hereby authorize
City of Cupertino
understands and
$
%.
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.