B-2018-0964 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0964
976 NOVEMBER DR CUPERTINO,CA 95014-4121(362 13 025) AIR QUALITY
HEATING&AIR
CONDITIONING
INCORPORATED
SAN JOSE,CA 95126
OWNER'S NAME: DATE ISSUED:06/06/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_20 Lic.#769446
Contractor AIR QUALITY HEATING&AIR CONDITIONING INCORPORATED XBLDG_ELECT_PLUMB
Date 06/30/2019 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm 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 JOB DESCRIPTION:
license is In full force and effect. REPLACE FURNACE(SAME LOCATION)AND ADD A/C UNIT
1 hereby affirm under penalty of perjury one of the following two declarations: (BACK OF THE HOUSE)
z. I have and will maintain a certificate of consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,For the
performance ofdre 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 Arca: Valuation:$17950.00
permit is issued
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 362 13 025
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 regulation per the Cupert� unicipal Code,Section 9.18.
Issued by:Kim Dunbar
Signature6e// Date 06106/2018 Date:06/06/2018
OWNM11BUIL ER DECLARATION RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If e roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
r. 1,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Cade) Signature ofApplicanr.
z. 1,as owner ofthe property,am exclusively contracting with licensed Date:06/06/2018
contractors to construct the project(See.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declm ations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the I arduus materials requirements under Clmptm•6.95 of the
2. 1 have and will maintain Worker's Compensation Insurencq as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.1 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
permit is issued Health&Safety Cade,Section 25532(1)should 1 store or handle hazardous
a. 1 certify that in the performance of the work for which this permit is issued,I rnaterial.Additionally,should I use equipment or devices which emit hazardous
shall not employ in an to become subject to the air contaminants as defined by the Bay Aran At-Qt Iity Management District 1
p y any person y maturer so as J will maintain compliance with the Cape i;ind Mn r ipal Code,Chapter 9.12 and
Worker's Compensation laws o£California.If,cf er making this certificate of the Health&Safety Code, a ns 2 5,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,l must forthwith comply with such provisions or this permit shall Owner or authorized agent: /
be deemed revoked. Date:06106/2018 /
APPLICANT CERTIFICATION C 'RUQ7'ON/. CY
ENDI A,EN
I certify that I have read this application and slate that the above information is hereby affirm that there -a consiructlon lendi g 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 Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18. _
Licensed