B-2018-0045CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0045
22998 STANDING OAK CT CUPERTINO, CA 95014-2660 (342 50 007)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
O\VNER'SNAM& BUTALAAMIT P AND DESAI MAMATA D TRUSTEE
DATE ISSUED: 01/08/2018
OWNER'S PHONE:
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMITINFO:
License Class C20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 1213112018
X BLDG —ELECT —PLUMB
X MECIi X RESIDENTIAL COMMERCIAL
1 hereby nflirm that 1 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 (N) AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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
Pat formance of the work for which this permit is issued.
'�%'jCf I have and will maintain Worker's Compensation Insurance, as provided far by
66
�(J Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valentina: $11250.00
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 stale laws relating to building construction, and hereby authorize
342 50 007
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 Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION,
/
Date 01-8-2018
Issued by: Kim Dunbar
Date: 01/08/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law tm' one ot'the
RR-BOQFS•
following two reasons:
All inch; shall be inspected pnoi to any roofing material being installed. If a roof is
t. 1, 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 ofYered for
inspection,
sale (Scc.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: 01-8-2018
1 hereby affirm tinder penalty of perjury one of the following three declinations:
ALL ROOF COVERINGS TO 13E CLASS "A" OR BETTER
t. 1 have and will maintain a Certificate of Consent to self-insure fmWorker's
-
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work too which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
f have read the hazardous materials requirements order 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. 1 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
shall not employ any person in any manner so as to became subject to the
material. Additionally, should I lose equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality IDlanagement District I
Worker's Compensation laws of California. If, ager 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 in of the
the Health & Safety Code, Sections 25505, 25533, and 225555+3
Labor Code, I oast Forthwith comply with such provisions or this permit shall
be deemed revoked.
J4.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 01-8-2018
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct, I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a constructionlending 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 01-8-2018
Professional