BLD-2021-1274BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 6101 BOLLINGER RD Cupertino
APN: 375 38 008
PERMIT NO: BLD-2021-1274
OWNER'S NAME:
OWNER'S PHONE: Not Provided
CONTRACTOR: SILVA ADRIANO, 201 SINGLETON AVE APT D ALAMEDA
CONTRACTOR PHONE:
DATE ISSUED 7/16/2021 3:06:12 PM
ISSUED BY: Sean Hatch
VALUATION: $22400
JOB DESCRIPTION
FLINTLASTIC 2-PLY SYSTEM; INSTALL (1) LAYER OF BUILT UP ROOF OVER (E) LAYER OF BUILT UP ROOF - (28 SQ) CLASS A REQUIRED PER ICC REPORT
OVERLAY ROOF WITH CERTAINTEED
ES R-1388
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C39
LICENSED
EXP
05/31/2023
I hereby
force
I hereby
SILVA ADRIANO
CLASS:
ROOFING
NO: 1075380
DATE:
affirm that I am licensed
and effect.
affirm under penatiy
I have and will maintain
for which this permit is
I have and will maintain
I certify that in the performance
laws of California.
with such provisions
under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
issued.
Worker's Compensation Insurance,
of the work for which this
If, after making this certificate
or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
work
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
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the Health
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with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 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
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CONSTRUCTION LENDING AGENCY
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 that there is a construction
No
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Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter 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 that I
construction,
harmless the
the applicant
Signature:
have read this
and hereby authorize
City of Cupertino
understands
application and state that the above
representatives of this city
against liabilities, judgements, costs,
and will comply with all non -point source
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.