10080124CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7467 HEATHERWOOD DR
CONTRACTOR: ABOVE ALL ROOFING
PERMIT NO: 10080124
OWNER'S NAME: JOHN G AND GERALDINE METZGER
700 NORTHRUP ST
DATE ISSUED: 08/18/2010
NE 'S PHONE: 4082528081
SAN JOSE, CA 95126
PHONE NO: (408)2924188
LICENSED CONTRACTOR'S DECLARATION
r— ELECT r PLUMB r
License Class C 3 Lic. # r
BUILDING PERMIT INFO: BLDG
MECH r RESIDENTIAL I—COMMERCIALr
�, �
_Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: RE -ROOF TEAR OFF EXISTING HEAVY SHAKE. INSTALL
(commencing with Section 7000) of Division 3 of the Business & Professions
OSE ,INSTALL NEW 36X36 FELT. INSTALL NEW
Code and that my license is in full force and effect.
C O MPO;>ITION CLASS A 3SQ
I hereby affirm under penalty of perjury one of the following two declarations:
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft F nor Area:
Valuation: $9563
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. -4
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APN Number: 35926048.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
181) DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
Issued 1y -f-` Date:
_ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspectic n.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
-
Business & Professions Code)
Signatur -/f Ap licant: _ — Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have r, !ad the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
Califorr is Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
complia ice with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety C ode, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contami pants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health ti Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
dff:/
/ ��� Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
�ti
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 of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for whic i this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender'; Name
upon the above mentioned property for inspection purposes. (We) agree to save
Znify and keep harmless the City of Cupertino against liabilities, judgments,
Lender'; Address
and expenses which may accrue against said City in consequence of the
6_ .Aing of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
LicenserI Professional