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B-2016-1188 - Permit CardCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7529 RAINBOW DR CUPERTINO, CA 95014-5235 (362 30 017) CONTRACTOR: (PERMIT NO: B-2016-1188 (ON-TIMEAIR CONDITIONING & HEATING INC ) PLEASANTON. CA IOWNEWSNAME: I JDATF ISSUED: 01/14/2016 1 LICENSED CONTRACTOR'S DECLARATION �2 License Class Lic. If v 170 Lf 0 G 9 0 Contractor (ON -TIME AIR CONDITIONING & HEATING INC ) Date //2104; I hereby affirm that I 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. hereby affirm under penalty of perjury one of the following two declarations: 1. 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 source regulations per the Cupertino Municipal Code, I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: s. I, as owner of the property, or my employees with wages m their sole compensation, will do the work and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed contractors in construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: m. 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. r. I 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 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so w to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. artily that I have read this application and state that the above information is mect. 1 agree to comply with all city and county ordinances and state laws lsting to building construction, and hereby authorize representatives of this city enter upon the above mentioned property for inspection purposes. (We) agree save indemnify and keep harmless the City of Cupertino against liabilities, figments, costs, and expenses which may accrue against said City in nsequence of the granting of this permit. Additionally, the applicant iderstands and will comply with all non -point source regulations per the mpertino Municipal Code, Section 9.18. PERMIT INFO: BLDG —ELECT —PLUME MECH $ RESIDENTIAL _ COMMERCIAL DESCRIPTION: tce furnace is closet. Ft Floor Area: I Valuation: $4080.00 30 017 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by:, L RF_ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fast obtaining an inspection, I agree to remove all new materials for inspection. Appficanh HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505 33, and 25534. Owner or authori ad agent: Date: Ill/ 2f�lo I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCIrITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Signature Date Professional