B-2018-0963 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0963
19960 PEAR TREE LN CUPERTINO,CA 95014-2319(3[6 31 004) 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 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. INSTALL MINI SPLIT SYSTEM INDOOR UNITS(1)HEAT PUMP(1)
I hereby affirm under penalty of perjury one of the following two declarations:
a. 1 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
Parfet mance 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 this Sq.Ft Floor Area: Valuation:$535400
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 316 3I 004
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 1$0 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 pe the Cuppr.01 6 Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signature// Date 06/06/2018 Date:06/06/2018
OWN II�BUILDE ECLARATION RE-ROOFS;
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.Its mor is
following two reasons: installed without first obtaining so inspection,I agree to remove all new materials for
v I,as owner of the property,or my employees with wages as their sale inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec,7044,Business&Professions Code) Signature of Applicant:
z I,as owner of the property,am exclusively contracting with licensed Date:06/06/2018
emurectora to construct the project(Sec.7044,Business&Professm.Code),
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance orthe work for which this permit is issued. I have read the hazardous materials requirements matin Chapter 6.95 of the
z. 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 ofthe Labor Code,for the performs—of the work for which thism aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(x)simuld I store or handle hazard....
3. I certify that in the performance o£the work for which this permit is issued,I material.Additionally,should I use equipment m•devices which emit hazardous
shall not employ any peison in any m as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws ofC.lifomia.slf,after making this certificate of wtll maintain compliance with the CSects
Municipal Code,Chapter 9.12 and
the Health&Safety Cade, 25505,25533 trd 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,l most forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked Date:06/06/2018
APPLICANT CERTIFICATION
CONSI I2UCT1bNL N E Y
certify that have read this application and state that the above information is hereby affirm that there isonstrbctlon lending agent 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,(64 .)
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