BLD-2020-0670CITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 18850 TILSON AVE, Cupertino, CA 950143653
:
CONTRACTOR: KEVIN FARRER ENTERPRISES INC
CONTRACTOR PHONE: 5103666550
DATE ISSUED: 6/5/20 ISSUED BY: haleym VALUATION: moo
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF FOAM ROOF; INSTALL PVC SINGLE PLY 60MIL WHITE - (15
SQ)
LICENSED CONTRACTOR'S DECLARATION:
NO: 742713 EXP DATE: 11 /30/20
7000) of Division 3 of the Business Sr Professions
CONTRACTOR: KEVIN FARRER ENTERPF LICENSED CLASS: C39 LICENSED
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section
Code and that my license is in full force and effect.
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury one of the following three declarations:
0 I have and will maintain a certificate of consent to self -insure for Worker's Compensation,
/ Labor Code, for the performance of the work for which this permit is issued.
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
I have and will maintain Worker's Compensation Insurance, as provided for by
performance of the work for which this permit is issued.
■ I certify that in the performance of the work for which this is issued, I shall
permit
become subject to the Worker's Compensation laws of California. If, after making
the Worker's Compensation provisions of the Labor Code, I must forthwith comply
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534.1
1 I have read the hazardous materials requirements under Chapter 6.95 of the California Health
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
D An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification
®/
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
(Section 3097, Civil Code).
❑ Yes Si No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
and will comply with all non -point
0
I certify that I have read this application and state that the above information is correct. I agree to comply
laws relating to building construction, and hereby authorize representatives of this city to enter upon
purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.