D-2016-0399CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
7411 WILDFLOVMR WAY CUPERTINO, CA 95014-5309
CONTRACTOR:
PERMIT NO: D-2016-0399
(366 18 035)
CRAIG A ROGERS
CONSTRUCTION INC
SAN JOSE, CA 95136
OWNER'S NAME:
DATE ISSUED: 08/02/2016
OWNER'S PHONE:
PRONE NO: (408) 978-5484
LICL+NSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 13-1 Lic. #978553
Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11130/2015
—BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH,X RESIDENTIAL — COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Cade and thai my
license is in full force and effect.
JOB DESCRIPTION,
I hereby affirm under penalty of perjury one of the following two declarations:
DEMO (E) 1513 S.F. SFD; ATTACHED GARAGE 500 S.F.
i. 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.
ave 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.
Sq. Ft F1oorArea:
Valuation: $18000.00
APPLICANTVIRR IFjf T1 rN
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
36618 035
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, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence the granting this permit.
Additionally, the applicant undo ands and will comply with all non-point
l all
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS,
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sale
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (See.7044, Business & Professions Code)
i. 1, as owner of the properly, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 8-12/2U1�
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
a. • I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Arca Alr a ty Management District I
, maintain compliance with
for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree.
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabliities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply