BLD-2024-0016_SignedPermit.pdf ITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 11804 RIDGE CREEK CT APN: 366 04 030
PERMIT NO: BLD-2024-0016
OWNER'S NAME: HUI JAMES P S
OWNER'S PHONE:628-219-9038
CONTRACTOR: IRBIS HVAC INC
CONTRACTOR PHONE: 669-287-6465
DATE ISSUED: Jan 3. 2024 ISSUED BY:Jasmine Archbold VALUATION: 9481
JOB DESCRIPTION: REPLACE EXISTING WATER HEATER WITH NEW 65 GAL ELECTRIC HEAT PUMP
WATER HEATER IN GARAGE - SAME LOCATION
LICENSED CONTRACTOR'S DECLARATION:
NO: 1048009 EXP DATE: 01 /01 /2025
7000) of Division 3 of the Business & Professions
CONTRACTOR: IRBIS
I hereby affirm that I am licensed
Code and that my license is
HVAC INC LICENSED CLASS: C20 LICENSED
under the provisions of Chapter 9 (commencing with Section
in full force and effect.
of perjury one of the following three declarations:
and will maintain a certificate of consent to self -insure for Worker's Compensation,
Code, for the performance of the work for which this permit is issued.
as provided for by Section 3700 of the
I hereby affirm under penalty
❑ I have
Labor
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. I have
and will maintain Worker's Compensation Insurance, as provided for by
of the work for which this permit is issued.
that in the performance of the work for which this permit is issued, I shall
subject to the Worker's Compensation laws of California. If, after making
Compensation provisions of the Labor Code, I must forthwith comply
revoked.
performance
❑ I certify
become
the Worker's
deemed
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
materials requirements under Chapter 6.95 of the California Health
M I have read the hazardous
will maintain compliance
handle hazardous material.
Air Quality Management
Sections 25505, 25533,
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,
Additionally, should I use equipment or devices which emit hazardous
District I will maintain compliance with the Cupertino Municipal Code,
and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
Renovator will be responsible for this project.
Firm Certification
❑ An EPA Lead -Safe Certified
Certified Firm Name:
✓ 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
(Section AV7, Civil Code).
of perjury that there is a construction lending agency for the performance
Yes El 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
understands and will comply with all non -point
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,
accrue against said City in consequence of the granting of this permit. Additionally, the applicant
source regulationsper the Cupertino Municipal Code, Section 9.18.
Signature / ' /'" ItVAC
Date Jan 3, 2024
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE,
OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.