HomeMy WebLinkAboutB-2017-2016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-2016
7920 AUGUST LN CUPERTINO, CA 95014-4113 (362 12 017)
CUPERTINO ROOFING
INC
SAN JOSE, CA 95129
OWNER'S NAME:
DATE ISSUED: 11/22/2017
OWNER'S PHONE:
PHONE NO: (408) 973-9427
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C39 Lic. #565 3
Contractor CUPERTINO ROOFING INC Date 03/31/2018
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
RE -ROOF: TEAR -OFF; INSTALL OSB: COMP SHINGLES - (27 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
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
_
ve and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $15000.00
permit is issued.
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
362 12 017
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
Cit of Cupertino against liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
Issued b : Kim Dunbar
Y
Date: 11/22/2017
-BUILDER D L R I
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs
I
1 hereby affirm under penalty of perjury one of the following three declarations:
.AIS OF COVERINGS TO BE CLASS "A" OR BETTER
t. 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.
HAZARDOUS MATERIALS DISCLOSURE
z. 1 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.
aintai ompliance with the Cupertino Municipal Code,, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit tssued, I
Health & Sa ode, Section 25532(a) should I store or handle hazardous
'material.
shall not employ any person in any manner so as to become subjet to the
Additionally, uld I use equipment or devices which emit hazardous
air contaminants as defined th'e Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance
APPLICANT CERTIFICATION
Date: 11-22-2!��
I certify that I have read this application and state that the above information is
IONLENDING AGENCY
correct. I agree to Comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency 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 liabilities,
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 with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 11-22-2017
Professional