B-2017-2015 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2015
7876 BELKNAP DR CUPERTINO,CA 95014-4906(362 10 040) ON-TIME AIR
CONDITIONING&
• HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: BARON STEVEN TRUSTEE&ET AL DATE ISSUED: 11/21/2017
OWNER'S PHONE:408-499-1237 PHONE NO:(925)872-7326
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#817040 •
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 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 effe . JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION-CLOSET)
I hereby affirm under p alty of perjury one of the following two declarations:
1. I have and °ill maintain a certificate of consent to self-insure for Worker's
Compe :ation,as provided for by Section 3700 of the Labor Code,for the •
perfo'nance of the work for which this permit is issued.
61'I . e 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:$7559.00
, 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: Oceupancy,Type:
and state laws relating Ito building construction,and hereby authorize 362 10 040
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 agairist liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF;WORK IS NOT STARTED
may accrue against said City inconsequence of the gr ding of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant.understands and will co y with all non-point
source regulations per,the Cupertino Municip ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
4s, at ' 7thDate 11/21/2017 Issued by:Jasmine Archbold
Date: 11/21/2017 •
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any'roofing material being installed.If a roof is
r. 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: 11/21/2017
I hereby affirm under penalty of perjury one of the following three declarations: „
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS A OR BETTER
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 requirement's 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. 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,not employ any person in any manner so as to become subject to the should I use equipment or devices which emit hazardous.„-----
air contaminants as defined by the Bay Area Air Quality Management Dis
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Cha. • '.12 and
exemption,I become subject to the.Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,an. 534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. • _ `-•e&r authorized agent: . 110
APPLICANT CERTIFICATION ' 1/21/2017 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance
gelating 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 expense's 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. I understand my plans shall be used as public records.
Licensed
Signature ' Date 11/21/2017