HomeMy WebLinkAboutB-2018-0952CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR: PERMIT NO: B-2018-0952
20644 ACADIA CT CUPERTINO, CA 95014-1756 (326 56 018)
WESTSHORE
ROOFING INC
SAN JOSE, CA 95131
OWNER'S NAME:
DATE ISSUED: 06/04/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'SDECLARATION
BUILDING PERMIT INFO:
License Class Q.0 Lia #287221
Contractor WESTSHORE ROOFING INC Date 11/30/2018
X BLDG _ ELECT — PLUMB
MECH X RESIDENTIAL— COMMERCIAL
1 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 METALTILES (38 SQ)
I hereby affirm under penalty of perjury Due o£ the following two declarations:
CLASS A ASSEMBLY (3) SEE ICC SHEET ESR -1491 - 4A.1.5
v 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 c f the work for which this permit is issued.
permit is issued,
Sq. Ft Floor Area:
Valuation: $32000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and stale laws relating to building construction, and hereby authorize
326 56 018
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 of the granting of this permit
180 DAYS OF PERMIT
Additionally, the applicant understands and will comply with all non -point
WITHIN ISSUANCE OR
source regulations per the Cupor'no Municipal Code, Section 9.18.
1.80 DAYS FROM LAST CALLED INSPECTION.
Signature� — Date 06-04-2018
Issued by: Kim Dunbar
OWNER-BUIL. D'CLARATION
Date: 06/04/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS:
following ben reasons:
All roofs shall be inspected prior to any roofing material being installed. Its roof is
r, 1, as owner of the property, or my employees with wages as their sole
nstalled without first obtaining au inspection, I agree to remove all new materials for
compensation, will the work, and the sintchue is not intended or offered for
;{'
nt the pr
contractors to construct the project (Sec,7044, Business &Professions Code).
4-2018icant
Date: OC -04-2018
1 hereby affirm under penalty of perJury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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
1. 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. 1 will
is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit
s. 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. Additlonally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this cenifteate of
air contaminants as defined by the Bay Area Air Quality Management District I
ryHJ matotaln compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cod SeOkins 25 0 25533, a 5534.
Labor Cade, l must forthwith comply with such provisions or this permit shall
be deemed revoked
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 06-04-2018
I certify that I have read this application and state that the above Information Is
CONSTRUCTI N LEN ING 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 complywith all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARA'IJON
Code, Section 9.18.
understand my plans shall be used as public records.
Signature Date 06-04-2018
Licensed
Professional