BLD-2024-1648_SignedPermit.pdf ITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10473 LOCKWOOD DR APN: 342 29 008
PERMIT NO: BLD-2024-1648
OWNER'S NAME: RUDEN JEANNE MARIE HOTALING TRUSTEE
OWNER'S PHONE:
CONTRACTOR: ABOVE ALL ROOFING SOLUTIONS INC
CONTRACTOR PHONE:
DATE ISSUED: Aua 1. 2024 ISSUED BY:Jasmine Archbold VALUATION: 14300
JOB DESCRIPTION: RE -ROOF; TEAR -OFF; ASPHALT SHINGLES (2870 SF); CLASS A ROOFING
LICENSED CONTRACTOR'S DECLARATION:
NO: 794435 EXP DATE: 04/30/2025
7000) of Division 3 of the Business & Professions
CONTRACTOR:
I hereby affirm
Code and
ABOVE ALL
that I am licensed
that my license is
under penalty
ROOFING SOLUTIONS INC LICENSED CLASS:C39 LICENSED
ROOFING
under the provisions of Chapter 9 (commencing with Section
in full force and effect.
of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's Compensation,
for the performance of the work for which this permit is issued.
as provided for by Section 3700 of the
I hereby affirm
❑ I have and
Labor Code,
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
I. I have and
will maintain Worker's Compensation Insurance, as provided for by
of the work for which this permit is issued.
in the performance of the work for which this permit is issued, I shall
to the Worker's Compensation laws of California. If, after making
Compensation provisions of the Labor Code, I must forthwith comply
revoked.
performance
❑ I certify that
become subject
the Worker's
deemed
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
read the hazardous
compliance
hazardous material.
Management
25505, 25533, and
materials requirements under Chapter 6.95 of the California Health
M I have
will maintain
handle
Air Quality
Sections
with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
Additionally, should I use equipment or devices which emit hazardous
District I will maintain compliance with the Cupertino Municipal Code,
25534.
EPA LEAD -SAFE DISCLOSURE
No:
Lead -Safe Certified Renovator will be responsible for this project.
Firm Name: Firm Certification
❑ An EPA
Certified
✓ No EPA
Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty
(Section AV7, Civil Code).
of perjury that there is a construction lending agency for the performance
Yes El No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
I certify that
laws relating
purposes.
accrue against
source regulations
Signature
I have read this application and state that the above information is correct. I agree to comply
to building construction, and hereby authorize representatives of this city to enter upon
(We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
said City in consequence of the granting of this permit. Additionally, the applicant
per the Cupertino Municipal Code, Section 9.18.
Date Aug 1, 2024
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.