B-2017-2101 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2101
1605 ASTER LN CUPERTINO,CA 95014-5214(366 24 013) DONE RIGHT INC
CAMPBELL,CA 95008
OWNER'S NAME: TSUKAMOTO MARIAN M TRUSTEE' DATE ISSUED: 12/07/2017
OWNER'S PHONE: PHONE NO:(408)377-8777
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39, Lic.#774962
Contractor DONE RIGHT INC Date 02/28/2018 X 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 Code and that my
license is in full force and effect. , JOB DESCRIPTION: -
RE-ROOF;TEAR-OFF;'INSTALL COMP-(29 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
performance of the work for which this permiyis 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.
Sq.Ft Floor Area: Valuation:$15500.00
• 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 366 24 013
representatives of this city to enter u'p'on 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 of the granting of this permit. WITHIN 180 DAYS.OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations • t upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12-07-2017 Issued by:Kim Dunbar
''•' Date: 12/07/2017
OWNER-BUILDER'DECLARATION
I hereby affirm that'I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: ' 1 •1 , All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,.as'owner,of the property,Jr my employees with wages as their sole 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 ction.
sale(Sec 7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct'the project(Sec.7044,Business&Professions Code). Date:12-07-2017
1 hereby affirm under penalty of per iry.''one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have andwill maintain a,Certificate.of Consent to self-insure for Worker's
Compensation,as'.provtded for by Section 3700 of the Labor Code,for the
•
performance of the work6forrwhich this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 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'L'abo'r Code;for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
i; maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. i a;
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the.performanoe of the work for which this permit is issued,I
, material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Workers Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption I become subjectito the Worker's Compensation provisions of the the Health&Safety Code,Sect ons 2 505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked ) ;;i Owner or authorized agent:
i i APPLICANT CERTIFICATION Date:12-07-2017
I certify that I have read thisapplidation;and state that the above information is CONSTRUCTION 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 Thereby 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,lexpenses which may accrue against said City in Lender's Address
consequence of the,granting of•this permit. Additionally,the applicant understands
and will comply non-point,source regulations per the Cupertino Municipal • ARCHITECT'S DECLARATION
Code,Section 9.18: I understand my plans shall be used as public records.
Licensed
Signature Date 12-07-2017 professional