B-2018-1283 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1283
18770 TUGGLE AVE CUPERTINO,CA 95014-3624(375 27 021) WING'S ROOFING INC
CASTRO VALLEY,CA
94546
OWNER'S NAME: DATE ISSUED:07/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#698113
Contractor WING'S ROOFING INC Dale 09/30/2019 X BLDG ELECT—PLUMB
1 hereby affirm that I am Ilemaiud under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Pruf'essions Code and that my
license is In full farce and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;INSTALL COMP SHINGLES-(20 SQ)
I hereby affirm under penalty at'perjury one of the fallowing two declarations:
t. 1 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.
have and will maintain Worker's Compensation insurance,as provided for by
�Scetion 3700 of the Labor Code,for the pmformance of the work for which this
permit is issued. Sq.IT Floor Area: Valuer-:$7800.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 375 27 021
representatives of this clfy 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 WORI{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 per the Cupertino Municipal Code,Section 9.18. 1.80 DAYS FROM LAST CALLED INSPECTION.
Signature _% Date 07130/2018 Issued by:Jasmine Archbold
Date:07/30/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law I'or one of the RE-ROOFS:
following two reasons: All roof's all be inspected prior to any roofing material being installed.Ira reef is
L 1,as owner of the property,or my employees with wages as their sole installed without first obtaining rm inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code)
z. I,as owner of tre property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/30/2018
I hereby affirm under penalty of perjury one of the following three declarations: PLL ROOF COVERINGS TO BE CLASS"A"OR BETTER
C. I have and will maintain a Certificate of Consent m self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I hove 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
permit is issued matntsdn compliance with the Cupertino Municipal Code,Chaptor 9.12 and the
s. I certify that in the performance of dre 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 moaner so as to become sublect w the matental.Additiomdly,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,If,aftermaking this certificate oIwill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Date:07130120 18
I certify that I have read this application and Slate that the above information is CONSTRUCTION LENDING 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 bullding 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 Clty 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 Al2CH1'I'EC'f S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 07/30/2018
Professional