B-2018-0992 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0992
6397 COTTONWOOD CT CUPERTINO,CA 95014-4620(369 18 016) CONDITIONED AIR
ASSOCIATES INC
SAN JOSE,CA 95125
OWNER'S NAME: DATE ISSUED:06/12/2018
OWNER'S PRONE: PHONE NO:(408)291-2220
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lid.4445162
Contractor CONDITIONED AIR ASSOCIATES INC Date 08/31/2019 X BLDG ELECT_PLUMB
hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. 30B DESCRIPTION:
REPLACE FURNACE-SAME LOCATION;REPLACE DUCTING;(N)
1 hereby affirm under penalty of perjury one of the following two declarations: A/C UNIT-SIDE YARD
L I have and will maintain a certificate of consent to self-insure for Worker's
C pensation,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 Iasumnee,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:$7000.00
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 AIN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 18 016
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
I hereby affirm that I am exempt from the Contractor's License Lav to,-one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roaring material being installed.If a roof is
t. 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 snvcdue is not intended or offered for inspection.
sale(Sec,7044,Business&Professions Cade)
z. I,as owner of the property,am exclusively contracting with licensed Signature,,£Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:06/1212018
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-insnm 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
z 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,Rr 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
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I star,,or handle hazardous
shall not employ any person in any manner so as to become Subject to the material.Additional)
I 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 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.)
toenter 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 ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records,
Licensed
Signature Date QDL ZL180
Professional