Loading...
B-2017-1184I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1184 20172 RODRIGUES AVE CUPERTINO, CA 95014-3100 (369 32 049) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: TIRUTHANI SARAVANAIKUMAR V AND NAGAPRIYA DATE ISSUED: 07/21/2017 OWNER'S PHONE: 408-768-4585 PHONE NO: (408) 294-6290 LICENSED ONT OR' DECLARATION BUILDING PERMIT INFO - License Class C-20 Lic. #258540 Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG —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 FURNACE (SAME LOCATION); INSTALL (I) AC UNIT 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. 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 Sq. Ft Floor Area: Valuation: $19542.00 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 369 32 049 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 7/21/2017 Issued by AbbyAyende OWNER DECLARATION I Date: 07/21/2017 -BUILDER 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) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 01 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. 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. s. 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 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: 7/21/2017 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 Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands FCT ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal e used as public records. I understand my plans shhallall bbe Code, Section 9.18. Licensed Signature Date 7121/2017 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CU l;ii'INO (408) 777-3228 • FAX (408) 777-3333 • building cuperkina.org misc PROJECT ADD S /) (1-7 Ll i p APN # _52 OWNER NAME 9r� t4^, 0/ PHON 9?I� j MAIL STREET ADD b [7 w vU AWT(.,4 cA ^ FAx CONTACT NAMED _ CL I )1 PFIONES � i` t �j V O E-MAIL STREETADDRESS _ �" CITY, STA, E"'Zl FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT -CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME q / ' / OV _ A LICENSE NUMBED. �. LICENSE TYPE � n G���� BUS. LIC 4 COMPANY NAME V V, llu qxp-4�131 E-MAIL �j1.1oj V ct, j � m STREET ADDRESS -1 l j I t w CITY, STA cl� ')'O�� y 1 y? t !I L_ PHO ARCHITECTIENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO 7PROOJECTOIN ❑ YES DZNE NO IS TBE BLDGAN ❑ YES HOME? ❑ NO 9%❑' �IEICBLER DESCRIPTION OF WORK....n?J /1 17� MEPMiscApp_2011.doc revised 06121111 d"WW'