HomeMy WebLinkAboutB-2018-1071CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR: PERMIT NO: B-2018-1071
7611 HOLLANDERRY PL CUPERTINO, CA 95014-5070 (362 26 065)
WESTSHORE
ROOFING INC
SAN JOSE, CA 95131
OWNER'S NAME:
DATE ISSUED: 06/26/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ROOFING LIc, #Z87221
Contractor WESTSHORE ROOFING INC Dale 11/30/2018
X BLDG ELECT _PLUMB
MECI4 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; IB ROOF OVERLAY - (5 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
u 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.
z. 1 have and will maintain Worker's Compensation Insurance, as provided for by
JL Section 3700 of the Labor Code, for die performance of the work fm which this
4l 1 permit is issued.
Sq. Ft Firm- Area:
Valuation: $6000.00
APPLICANT CERTIFICATION
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
362 26 065
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations Code, Section 9.16.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 0 612 612 01 8
Issued by: Jasmine Archbold
Date: 06/26/2018
OWNER -BUILDER ECLARATION
I hereby affirm that I am exempt from the Contractor's License Lmv tor one of theRE-ROOFS:
following two reasons:
All roars shall be inspected prior to any roofing material being installed. If a naafis
r. 1, as owner of the property, oi my employees with wages as their sole
undated without fust obtaining on inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
'
contractors to construct the project (See.7044, Business & Professions Code),
Date: 06/26/2018
I hereby affirm under penalty of perjury one of the following three declarations:
ALLIR COVERINGS TO BE CLASS "A" Oli 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 pat art 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, -1 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should 1 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 ar devices which emit hazardous
Worker's Compensation laws of California. trotter making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, l become subject to the Worker's Compensation provisions of the
the Health & Safety de, Secthu s� O5, 25533 and 25534.
Labor Code, I must forthwith comply with such In or this permit shall
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be deemed revoked,
Owner or authorized agent:
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.
Signature Data 06!26!2018
Licensed
Professional