B-2017-0407CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0407
7646 BARNI_ IART PL CUPERTINO, CA 95014-5239 (366 24 017)
AIRPRO MASTER INC
LAS VEGAS, NV 89102
OWNER'S NAME: ROSENTHAL JANE L AND JACK A
DATE ISSUED: 03/10/2017
OWNER'S PHONE: 408-838-8990
PHONE NO: (702) 598-4174
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C20 C36 Lie. #1012763
Contractor AIRPRO MASTER INC Date 04/30/2018
X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REPLACE 40 GAL WATER HEATER,(GARAGE)
I 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.
ifI 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
Sq. Ft Floor Area:
Valuation: $1300.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
366 24 017
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
will comply with all non -point
Additionally, the applicant understandJun
source regulations per the Cupertinoipal Code, Section 9.18.
180 DAYS FRO ION.
kiRto"I'Date
Signature 03/10/2017
Issued by: MELISSA N
OWNER -BUILDER DECLARATION
Date: 03/10/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the propert); am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 03/10/2017
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 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.
HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Munici al Cde, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cod . Sections 25505, 53 , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:,;
APPLICANT CERTIFICATION
Date: 03/10/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lenders Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S RATION
and will comply with all non -point source regulations per the Cupertino Municipal
public
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 03/10/2017
Professional
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.ora
CUPERTINO misc
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❑ OWNER ❑ OwNER-BuiLDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
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LICENSE NUMBER
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CITY, STATE, ZIP
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USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCLSL
PROJECT IN WH.DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ `vEs
EICHLER HOME? ❑ NC
DESCRIPTION OF WORK
TOTAL VALUATION: /�
RBC
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on e wner's behalff —avrTevtl this
application and the infonnation I have provided is correct. I haXe read the Description of Work and verify it is accurate. I agree to c mply with all applicable local
ordinances and state laws relating to ilding constru n. I thorize representatives of Cupertino to enter the above -id nttified pr perry for inspection purposes.
Signature of ApplicantlAgent: si–C $ Date: 3 /� v
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD '
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❑ LARGE_
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❑ MAJOR
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