BLD-2021-2039BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10998 SYCAMORE DR Cupertino APN: 342 56 030 PERMIT NO: BLD-2021-2039
OWNER'S NAME: GOTTLIEB ROBERT S AND MCDONOUGH JILL J TRUS OWNER'S PHONE: Not Provided
CONTRACTOR: ALL WEATHER ROOFING, 8907 CHURCH STREET GILROY CONTRACTOR PHONE:
DATE ISSUED 10/13/2021 12:19:20 PM ISSUED BY:VALUATION: $47200
JOB DESCRIPTION
Tear off existing wood shakes over cap sheet roof. install new underlayment, new wood batts, and new lightweight roofing tile 7.2lb per sq. ft.
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: ALL WEATHER ROOFING
LICENSED CLASS: C39 ROOFING
LICENSED NO: 913110
EXP DATE: 03/31/2022
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
force and effect.
I hereby affirm under penatly of perjury one of the following three declarations:
1 I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
2 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
3 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
I understand and agree that I am electronically signing and filing this application and that checking the box below has the same legal effect as manual signature. I also
understand that I have the option of filing a paper copy of this application with a manual signature but have chosen instead to file this application electronically.