B-2018-1654CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-1654
19387 SAKURA WAY CUPERTINO, CA 95014-3432 (375 03 015)
YORKSHIRE ROOFING
OF NORTHERN
CALIFORNIA INC
LIVERMORE, CA 94550
OWNER'S NAME: LIU CYRUS YAN AND SHIN ROO TRUSTEE
DATE ISSUED: 09/28/2018
OWNER'S PHONE:
PHONE NO: (925) 606-6700
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C39. C2 Lic. #$41422
Contractor YORKSHIRE ROOFING OF NORTHERN CALIFORNIA INC Date
X BLDG —ELECT _ PLUMB
07/31/2019
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
JOB DESCRIPTION:
license is in full force and effect.
RE -ROOF - TEAR -OFF - INSTALL LIGHT WEIGHT STEEL TILE (24.5
SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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. 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
Sq. Ft Floor Area:
Valuation: $19900.00
pemrnit is issued.
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
375 03 015
and state laws relating to building struction, and hereby authorize
representatives of this city to ant upon the above mentioned property for
inspection purposes. (We) agr to ve indemnify and keep harmless the
PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liab' ties, judsagments, costs, and expenses which
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said C' in consequence of the granting of this permit.
Additionally, the applicanVinderstands and will comply with all non -point
180 DAYS FROM LAST CALLED INSPECTION.
source regulations Cupertino Municipal Code, Section 9.18.
Issued by: Haley McKee
Signature Date 09/28/18
Date: 09/28/2018
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roof material being installed. If a roof is
following two reasons:
installed without fust obtaining an inspectio , I agree to remove all new materials for
t. I, as owner of the property, or my employees with wages as their sole
inspe ion.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
z. I, as owner of the property, am exclusively contracting with licensed
Date: 09/28/18
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requiremen/un
Chapte 6.95 of the
z. I have and will maintain Worker's Compensation Insurance, as provided for by
California Health &Safety Code, Sections 255, and 534. I will
Section 3700 of the Labor Code, for the performance of the work for which this
maintain compliance with the Cupertino MunicipC. C ter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) shouldr andle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment orhich emit hazardous
shall not employ any person in any manner so as to become subject to the
�' contaminants as defined by the Bay Area Air anagement District I
will maintain compliance with the Cupertino Muode, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 255, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:
be deemed revoked.
Date: 09/28/18
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Professional
Signature Date 09/28/18