12080115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18477 EDMINI'ON DR CON'IRACI'OR:AIR MAZE SERVICES INC PERMITNO: 12080115
O\\'NER'S NAME: MARATIili MADIiAV V AND MINAKSIiI M 933 KIFER RD STE A DA'Z'E ISSUED:08/102012
OWNER'S P110,\li: 4088650220 SUNNYVALE.CA 94086 PI IONENO:(Ja8)738-0333
❑ I:ICIiNSI?U CON'I'IG\CEOR'S DI?CL,\K,VfION BUILDING PERMIT INFO: DLDG r ELECT r PLUMB r
License Class L- ZU Lic.N- Cf J 2 �7. 1
• MECIi r RESIDEMI'LU, r COMMERCIAL r
Contractor A,(L ILJ1l2f )¢n)t(t) Date e- 10 17-
1 hervby
Zthereby affirm(hill l am.licensed under file provisions of Chapter 9 •1013 DESCRIPTION: REMOVE AND RI31'LACETHE CONDENSING UNIT
(commencing with Section 7000)of Division 3 of the Business S Profe5NOi6
Code and that my license is in full force and effect
I hereby affirm ander penalty of perjuy one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided I'or by Section 3700 of the Labor Cade,for the
performance oflhe work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3970
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code•for the performance of the work for which this
permit is issued APS Number:37522068.00 OccupancyType:
APPLICANJ CERTIFICATION
I certify[hal I have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,mad hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgmcros, 1S0 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply / o
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: � /� /G Date: e -/0
9.18. ry r
Si^_nalure Dale t/-/U'
RE-ROOFS:
❑ OWNER-RUILDERR DECLARATION All roofs shall be inspected prior to any roofing material being installed.if a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm thou I nun exempt from the Contractor's License I:nv for our of inspection.
the following svu reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and(he structure is not intended or olTered for sale(Sec.7044,
Business x Professions Code)
1,as owner of the property,:un exclusively contracting with licensed contractors to ALA.ROOF COVERINGS TO RE CLASS"A"OR RE111'.14:
construct the project(Sec.7044,Business&Professions Code).
1 hereby al iron under penalty of perjury one of(he following three IL\%,\RDOUS DL\'I'Ii121A1 ti DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health S Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Compensation,its provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
performance of the work for which this permit is issued Safety Code,Section 25.532(a)should 1 store or handle ha72rdous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hwardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined be the Ran.Area Air Quality Mlanagement District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Iealth&Safety Code.Sections 25505,25533,and_5534.
1 certify that in the performance of dile work for which this perniil is issued.I shall
nal employ any person in may manner so as to become subject m the Worker's crer omhori ee TTR zip
Compensation lases of California. If,after making this certificate of exemption,( Dale: 8-10-t"
become subject to the Worker's Compensalion provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be devoted revoked. CONSIRII -HON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Nanic
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep hardcss the City of Cupertino against liabilities,judgments, ,\RCII I'1'I'CI"S DECLARATIONcosts,and expenses which may accre against said City in consequence of the
granting of this permit.Additionally the applicant understands and will comply I understand my plans shall be used as public records.
with all non-paint source regulations per the Cupertino Municipal Code,Section
9.18, Licensed Professional
Signature Date
GENERAL PERMIT APPLICATION M E P
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COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVEAVENUE • CUPERTINO, CA 95014a3255
A '
CUPERTINO (408)7T(-3228 • FAX (408) ri7-3333 • building0cuoerinO.oro
❑PLL�L3LNGCF 4MCAL. ❑7LECI C,LL ❑ US
�( PRO,=ADDRSS I APNR ' ( / 41
/\ 18u,1 Edwrrn t-oYl �r-W e. � �(f o
OWNER NAME KinglLsht Mara{ke ?~±oNE °>�fo�') 07-zo I rrti
STAEETAODRESS C[TY. STAT;IIP FAX
IGV1� Clmrnhon t7r1v( I Gu errt-arLo CA 9601"(
COMACT NAME PHONE MA=
mantel Rt5yero-� I Li,OP, 738 0333
STREETADDRESS V CF ,TATE ZIP FAX
933 k�6cr Qond AA, SunnawLe C4 'VVObCo
❑ OvN ❑ OWNER-SUEJER ❑ OWNERAG, BCONTRACTOR El COM C ORAGF ❑ ARCTT?CT ❑=vmlTEZR ❑ DE TILOPER ❑ Tr?IANT
CONTRACTOR NAAfE \ I R �k l I'n` I LCI:NE NUMB R LICENSE T E I BUS.LIC p
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/ CONO'AN'Y NAME E-MAE. FAX
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S i F.M ADDRESS C'TY•STAT;Z1 PHONE
9. 3 14�er
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NA.' uCENSEt"UN TER
CO\eANY NAME' FAX
STREETADD c I C,1.,STAT$LR PHONE
USE OF OSFOm DUPLEX ❑ MULIT-FAt+m.Y PROIECTDJ WD.OL ❑ YES PR=C:IN ❑ YES STI BLDGAN ❑ Yz
BU=NC: ❑COMMERCW. URBAN iNTERFAC ARFa NO FLOOD ZONE "GZNO EIC'D-'J'i HOMET NO
DESCRIFnON OF WOR-)t
Xeo lau- coyIC-p-✓15i!' Jflll W I VLQ 1
TOTAL VALUATION: RECEIVED BY:
By my signature below,I c__-`fy to each of the following: I am the property owoer or authorized agent to ac:on the pmpery mvne:'s behalf I have read this
application and the in ormaion I have provided is correct -ba. read Description of Work and verify is is accurate. I agree;o comply wii all applicable local
ordinances and state laws reiatirg to b ng ct1Hs ,: on. I au•-r .reDrese,^.=Zve,of Cupcm c:c c^te:Lye above-id�ti5"d pmpc--for inspection pu�oscs.
re
Signatuof Applicar:dAgrc Dam: V l t O7t Z'
SUPPLEN=.-',L.A1FORI L4rON REQUIRED
OFFICE USE ONLY
y Ov'ER.THE-COUNTER
❑ EXPRESS
u
❑ STANDARD
V
❑ L\RCE
❑ NwOR
I Iv PAfUC4pp}011.dOC revised 06/21/11