B-2017-2074 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR. PERMIT NO:B-2017 2074
10893 SWEET OAK ST CUPERTINO,CA 95014(326 51 040) A&H HEATING&AIR
CONDITIONING I
SERVICE INC I
SAN JOSE,CA 95110 1
OWNER'S NAME: DOS SANTOS CARLOS AAND VIJAYA VENKATACHALA DATE ISSUED•12/05/2017
OWNER'S PHONE: PHONE NO:(408)279-0722
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class C-20 Lic.#304472 X BLDG _ELECT _PLUMB
Contactor A&H HEATING&AIR CONDITIONING SERVICE INC Date X MECH X RESIDENTIAL_COMMERCIAL
05/311/2019
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 JOB DESCRIPTION
license is in full force and effect. REPLACE FURNACE(SAME LOCATION);ADD A/C UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
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
jterfonnance 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 thisSq Ft Floor Area: Valuation.$6885.00
permit is issued.
APPLICANT CERTIFICATION APN Number Occupancy Type:
I certify that I have read this application and state that the above 326 51 040
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by•Abby Ayende
;Sig antur Date 12/5/2017 Date: 12/05/2017 -
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirmthat I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for
following twwo reasons: inspection.
i. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:12/5/2017
contractors to construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
i. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
2, I have and will maintain Worker's Compensation Insurance,as provided for by
California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued. material. Additionally,should I use equipment or devices which emit hazardous
a. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the ���
be deemed revoked. G Date:12/5/2017
APPLICANT CERTIFICATION hereby affirm that there is a construction lending agency for the performance CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097 Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
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 Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant understands I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18.
Licensed
I Professional
Signature Date 12/5/2017