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B-2017-1117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1117 10858 SYCAMORE CT CUPERTINO, CA 95014-6558 (342 57 034) RANDO AAA HVAC INC SAN JOSE, CA 95125 OWNER'S NAME: MULLIGAN MICHAEL AND STEPHANIE TRUSTEE DATE ISSUED: 07/12/2017 OWNER'S PHONE: 408-772-3067 PHONE NO: (408) 293-4717 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-4C 4- C-20-20 Lie. #768871 X BLDG Contractor RANDO AAA HVAC INC Date 09/30/2017 _ELECT _PLUMB X MECH X RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: REPLACE AC UNIT (SAME LOCATION) 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. z. 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. Sq. Ft Floor Area: Valuation: $5685.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 342 34257 034 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 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 Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 07-12-2017 Issued by: Kim Dunbar DECLARATION Date: 07/12/2017 OWNER-BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RF_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) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 07-12-2017 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 2. 1 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 1 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 Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, 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: 07-12-2017 1 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's 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 and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 07-12-2017 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc CUPE�RTINIO (408) 777-3228 • FAX (408) 777-3333 • buildincIO-cupertino.orp B , a)l *— . I ❑ PLUMBING MMECHANICAL ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS .APN A �. C OWNER NAME ,� PILON _ E-MAIL STREET ADDRESS O O Ci ST.4 ' FAX CONTACT NAMEM-1 VT PHO E-MAIL STREET ADDRESS o S S a 00 C�GS ' / FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' aando I LICENSE NUMBED LICENSE BUS. LIC 4Rm ! - COMPANY NAME fV E -MAI F -will STREET ADDRESS I CITY, STATE, ZI ARCHITECTIENGINEER NAME TCENSENUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF X SFD or Duplex ❑ Multi -Family STRUCTURE: E]Commercial PROJECT IN WILDLAND TURBAN INTERFACE AREA El Yes ❑ NO PROJECT IN FLOOD ZONE EI Yes El No DESCRIPTION OF WORK I /'y Cor1 U ff TOTAL VALUATION: RECEIVED /: [ i 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. 1 have read this' application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat g bu ding constfkctiqp. 1 authorize representatives of Cupertino to enter the abovekidentifieloperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE 0NLY ❑ OVER-THE-COUNTER i f X U U ❑ EXPRESS ❑ STANDARD. <. ❑ LARGEi.'. i ❑ MAJOR MEPMiscApp_2011.doe revised 03116111