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CITY OF CUPERTINO BUILDING PERA
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'B D DRESS: J CONT AC R: PERMIT Nth{B-2019-0439
I
I I "E l;ING RI LIFE �`IN0. A 95014-502)1062 X62 2 05 ���� � i" �
ROOFING INC
GILROY
CA 95020
OWNED' NAME; DATE ISSUED:031114/2019
OWN
� E O.(408) 945
R' PHONE:
A-)
:QR' ,nDL-L1AR 1 1 BUILDING PERMIT INFO:
License ClaspsLic,#122 113-71
Contractor fi _ . M 9 12 ,
INI E C It_X KL5 DE TIAL CO Q RCIAL
I hereby=affirm that f am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that MY
license is in full force and effect, JOB DESCRIPTION: 1
RE-ROOF;TEAR-OFF:COMP SHLNGLES(20 SQ)
I hereby affirm under penalry of perjury one of the following two declarations.,
I I have and will main in ae -ie e of c nyc g w cif-i 5:uc or Work_-`s
Compensation,as provided f$by Section 3 70 f the La-bor Code.for thX
perlotm ance of the work.for which this permit is issued= {
have and will maintain INVorker's opeeion Insurance,as provide 'or by
Section 3700 of the Laver Code,fir � �rfrmaof the work for which this
a� �. �..,.�.,w�,-e�. �.�..�e,,,. reeeww�.,�w..,reer„�,.,,errerr.�,...,� .w�r.�„
permit is issind.
alati
3
1 S .Ft Floor Area '' � � 3 3 £,
r
�4 �r.,n...a,.>e....n�vnrr..,... rerw.h..�nn.,,r_,�.....,.,,,_.,.„.,,_.�.,,.,re..,.,errr......_
I certify that 1 have read monis application and state that theabove
information is correct,I agree to comply with all city and count ordinances Pq��� � , � �� {
3 4
and state laws relating to building construction,an 600
hereby authorize
representatives of tits city to en upon above mentioned property for-
Inspection
t, = ,� � ��;. � � fes- .�.rrrewrwe„ner'� ,
City of Cupertino against liabilities,judgments,costs.and expenses which PERMIT EXPIRES
WORK
” - K-S NOT
� .ST �
may gai;ssaid City in consequence of the grantung of this permit. � WITHIN
_ _ � ,�PERMIT
Additionally,the applicant understands and pail comply£ h all non-print
��ITH N 180 DAYS OF PERM T ISSUANCE OR
-source regulations per the Cupertino
k-
� �� s Issued b �
Date 9 LIJj/"02
u
here-by affirm that f ant exempt from the Contractor's kerne Law for one of the
following two reasons,.
All rests shalt bec inspected prier to any oo'hing triatenial being in t lled:If a roof is
owner of � r� employees w�� yes as their sole installed without first obtaining art inspection,I agree to e ov�all[ ` materials fi„r
3
compensation,will do the work-,,ars the structnre is not intended or offered
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 Cruet to self-Insure for Worker's
r pem t or.,as provided for by Section 370,of the Laboir Code,for the
performance of the work for which this permit is issued.
I have and will maint in orker°s Compensation Insurance,as provided for by I have read the hazardous m terials requirementsunder Chapter 6.95 of the.
,� 'this' California Health&Safety Code,sections'5505,25533,and 25534. I will
Section � ofor ,I`r.�r performance ot � ��rl�} r w ,c ;�
issued, � maintaincompliance theCupertino MunicipalCode,chapter , 2 tie
per-mrt is Health&Befog:Cede,Section 25532(x)should f store r handle hazardous
3 I certify that in the perr om nce the work for which this peri;tit is issued,i {
shalt not c ply peen in = ger c be e material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay area Air Quality Management District l
W`orker's Compensation l os of California, If,seer making this certificate ofwill maintain:compliance with the Cupertino N-lunicipat Code,Chapter 9412 and
exemption,I become subject t€�the Workx is Coin ensati r�provisionsCif he
p � p the Health&safety Code,sections 25505,25533.and 2553C ;
Labor Code.I must forthwith comply,with such provisions or this peril shall i
be deemed revoked. gutter or authorized agent:
Date.* .
I certify that I have read this application and state that the above information s � �
'correct.i agree to comply with all city and county ordinances and State laws I hereby af�rrn that there is construction lending encfor the perfrr a�nce
relating to building 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. (Vve)agree �Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,anexpenses which mai,accrue against said{malty in �.8i�i$�r'�Address
consequence of the granfing of this permit, Additionally,the applicant understands'
and will comply with all non-point source regulations per the Cupertino k4unicipal AR tI l E
Code,Section 9.18, I understand my plans shall be used as public records,
Signature, Date 3-14-201
I_lceLicensedProfessional