HomeMy WebLinkAbout10080043 Permit CITY OF CUPERTINO B UILDING PERMIT
BUILDING ADDRESS: 10950 NORTHSKY SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10080043
OWNER'S NAME:
SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMB r
License Class L Lic.# Lr
/ Z 2!/O /� MECH r RESIDENTIAL COMMERCIAL
Contractor Date ld
JOB DESCRIPTION:RE-ROOF RMV EXISTING CEMWOOD ROOF&INSTALL
I hereby affirm that I am licensed under the provisions of Chapter 9 NEW
(commencing with Section 7000)of Division 3 of the Business&Professions GAF GRAND CANYON ASPHALT COMP 50YR ROOF SYSTEM,
Code and that my license is in full force and effect. ST014EWOOD IN COLOR 14SQ CLASS A
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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 Sq ,:t Floor Area: Valuation:$5200
permit is issued.
APPLICANT CERTIFICATION anc Occu Type:
I certify that I have read this application and state that the above information is APP l Number:31640059.00 Occupancy YP
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source r lations per the Cupertino Municipal Code,Section 180 DA FROM LAST CALLED INSPECTION.
9.18.
Signature Date « Iss ied by: -
Date: ��
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, ins ailed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, ins)ection. C, ^
Business&Professions Code) Sif nature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
I 1 ave read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall cc ntaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's in iintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I H!alth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner o Aor' agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: (J
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I iereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter fr r which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save
Lender's Name
--unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
g.....cing of this permit.Additionally,the applicant understands and will comply
with all non-point ource regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. z�l
I understand my plans shall be used as public records.
Signature Date
Licensed Professional