BLD-2020-1570BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10367 HENEY CREEK PL Cupertino
APN: 342 48 027
PERMIT NO: BLD-2020-1570
CONTRACTOR: C & E REMODELING INCORPORATED, 907 HARLISS AVENUE SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 10/1 /2020 4:20:45 PM
ISSUED BY: KDUNBAR
VALUATION: $5000
JOB DESCRIPTION
CDX; INSTALL COMP SHINGLES( 34 SQ);
RE -ROOF: TEAR -OFF; INSTALL
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
01/31/2021
I hereby
force
I hereby
DATE:
and
I have
for
I have
I certify
with
C & E REMODELING
CLASS:
BUILDING CONTRACTOR
NO: 1000465
INCORPORATED
under the provisions of Chapter
affirm that I am licensed
effect.
affirm under penatiy
and will maintain
which this permit is issued.
and will maintain
that in the performance
laws of California.
such provisions
of perjury one of the following three
a certificate of consent to self -insure
Worker's Compensation Insurance,
of the work for which this
If, after making this certificate
or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Co lie, for the performance of the
V
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of the California Health & Safety Code. Sections 25505, 25533. and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
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Certified
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code. Section 9.18.
I certify that I have read this
construction, and hereby authorize
harmless the City of Cupertino
the applicant understands and
Signature:
application and state that the above
representatives of this city
against liabilities, judgements,
will comply with all non -point
.‘
.