The URL can be used to link to this page

11100183 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10611 JOHNSON AVE CONTRACTOR:JIM'S AIR CONDITIONING PERMIT NO: 11100183 OWNER'S NAME: YU,TIM 917 QUERCUS CT DATE ISSUED: 10/26/2011 011-NER'S PHONE: 4087365900 SUNNYVALE,CA 94086 PHONE NO:(408)655-0491 �+ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C-AD Lic.# T t�6 blp I A ( MECH RESIDENTIAL COMMERCIAL Contractor�l."a t� p t IOE Date /6— (0— (( I hereby affirm that I am licensed under t provisions of Chapter 9 JOB DESCRIPTION:REPLACE TWO WALL FURANCES,SAME LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$2700 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. APN Number:37527013.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and 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,judgments, 180 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 with all non-point Rource regulations per the Cupertino Municipal Code,Section Issued by: Dater 9.18. e' r Signature �/^ Date n-a RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS 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&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owne r at Compensation laws of California. If,after making this certificate of exemption,I Laa Date: �l I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 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 Name 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 harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. WMi all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(d.cupertino.org misc []PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS � ApN* v 75 OWNER NAME PHOJ ,2 E-MAIL STREETADDRESS ` CITY, STATE,ZIP FAX CONTACT NAME ;( � -T- _ / PHONE !! ��JJ /, � V4 ag- 205 5 - f'S E-MAIL Deo 16, C� ��. CO STREET ADDRESS?/ eye V � CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME�. LI ENSE NUMBER _7LICENSE TYPE BUS.LIC# J/Nt6 I�i �DK t DK1rt �� C r�� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF ❑SFD or DUPLEX ❑ MULTI-FAMD Y PROJECT IN WIIALAND ❑ YES PROJECT W ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO TFLOO D ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: -7 o-o goo RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided_is eaFrect j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to •ldin ons cti ze representatives of Cupertino to enter the above-identified property for inspection pu(poses. Signature of Applicant/Agent- Date: SUP EMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS Y U w ❑ STANDARD T U ❑ LARGE ❑ MAJOR MEPMIscApp_2011.doc revised 06121111