BLD-2021-0535BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21387 METEOR DR Cupertino APN: 326 43 009 PERMIT NO: BLD-2021-0535
OWNER'S NAME: OWNER'S PHONE: Not Provided
CONTRACTOR: KENT ROOFING COMPANY INC, 1670 LITTLE ORCHARD ST SAN JOSE CONTRACTOR PHONE:
DATE ISSUED 3/18/2021 9:08:01 AM ISSUED BY:VALUATION: $17000
JOB DESCRIPTION
Remove 23 squares single layer composition shingles install Certainteed landmark roof system composition asphalt shingles install synthetic felt all new flashings to manufacture
specs and local codes
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: KENT ROOFING COMPANY INC
LICENSED CLASS: C39 ROOFING
LICENSED NO: 957398
EXP DATE: 05/31/2021
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.