B-2018-0912 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0912
10325 TULA LN CUPERTINO,CA 95014-2934(359 13 089) PELLE HEATING&
AIR INC
SAN JOSE,CA 95111
OWNER'S NAME: DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#809887
Contractor PELLE HEATING&AIR INC Date 10131/2019 X BLDG ELECT_PLUMB
I hereb farm that I am licensed under the X MECH X RESIDENTIAL_COMMERCIAL
y a provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is fn fall Puree and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);REPLACE AC UNIT
I hereby aflirm under penalty of perjury one of the fo11aW Ing two declarations: (SAME LOCATION)
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
I have and will maintain Worker's Compensation Insurance,es provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
permit Is issued. Sq.Ft Floor Area: Valuation:$8000.00
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 APN Number: Occupuncy'lype:
and stale laws relating to building construction,and hereby authorize 359 13 089
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We agree lo,save indemnify and keep harmless the
City of Cuper Ino againsfra ilities,ju gments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sai'Cit in cons quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ppllca I u erstend and will comply with all non-point
source regulatio per e u ertino f unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
1 hereby affirm that I out exempt Trani the Contractor's License Law 1'or one of the RE-ROOFS,
following two reasons: All roofs shall be inspected in 10 any roofing material being installed Ifs roof is
i. I,as owner of the property,of 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 offered For inspection.
sale(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Sitandme of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:05-29-2018
1 hereby affirm under penalty ol'perjury one ut'the following three declarations: ALL ROOD COVERINGS TO BE CLASS"A"OR BETTER
i. 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
performance ofthe 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 hazmslous materials requirements under 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.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,f Health&Safety Code,Section 25532(x)should I store"'nndle hazardous
shall not employ person in an material.Additionally,should 1 use equip Ie ices w Ich emit hazardous
1 y any p y manner se as to becmne subject to the .conmmiaants as defined by the Bay Area Q silly Ma agement District I
Worker's Compensation laws of California.If,after nicking this certificate of will maintain anuplismcc with the C rtiau nl Cad Cl`
9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Healtb&Safety Cade,
APPLICANT CERTIRICATION Data:05-29-2018
I certify that I have read this application and state that the above information is CQNSTRUCTION LJfC AC NC i
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lentling ag C'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.
Signature Date 05-29-2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0912
(0325 TULA LN CUPERTINO,CA 95014-2934(359 l3 089) PELLE HEATING&
AIR INC
SAN JOSE,CA 951 I1
OWNER'S NAME: DATE ISSUED;05/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CII Lic.#809867
Contractor PELLE HEATING&AIR INC Date 1013112019 X BLDG_ELECT_PLUMB
1 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 force and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);REPLACE AC UNIT
1 hereby sign.under penalty of perjury one of the following two declarations: (SAME LOCATION)
t. I have and will maintain a certificate o£consent to self-insure 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.
. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of fhc Labor Code,for the performance of the work fmwhich this
permit is issued. Sq.Ft Floor Area: Valuation:$8000.00
APPLICANT CF,RTIFICATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 13 089
representatives of this city to enter upon the above mentioned property for
inspection purposes. (W agree to save indemnify and keep harmless the
City of Cupertino agains4'((iall�lities,j gments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sal Clt m cons quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the too t u erstand and will comply with all non-point
source regulatio per e u crime,,un�icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
/'
Signature Date 05-29-2018 Issued by:Kim Dunbar
Data:05/29/2018
OWNER-BUILDER DE LAR"
I hereby affirm that I am exempt train the Contractor's License Lary to,-one of the RE-ROOFS,
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.11's roof is
t. I,as owner of the property,or my employees with wages as their sole in.,tolled without first obtaining an inspection,1 agree to remove all new materials far
compensation,will do the work,and the sit uchne is not intended or offered for inspection.
sale(Sce.7044,Business&Praressions Code)
z. Las owner of the property,am exclusively contracting with licensed Signature fApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:05-29-2018
1 hereby af'firrn under penalty of perjury one of tine 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
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
I. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous.atertots requirements under Chaptcr 6.95 of the
Section 3700 of the Labor Code,Ra the performance of the work for which[hisCalifornia P[ealth&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare or nudle hazardous
shall not employ any person in any manner so as to become subject to the natcerlal.Additionally,should I use equi'a i a evices wl fi emit huzardnus
ontaminnnts as defined by the Bny Aren.4 Qn"I t Mai agement District i
Worker's Compensation laws of California.If,after making this certificate of will maintain contplinnee with the C rtin0 VI it al Codd,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, tioas'255 t, 5533,.' 25534.
Labor Code,1 must forthwith comply with such provisions m this permit shall
;
I certify that I have read this application and slate that the above information is CONSTRUCTI( LN' ING A.
correct. agree to comply with all city and county ordinances and state laws hereby affirm that there is aconstruction lending ad, t 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 ARCIITITICT"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05-29-2018 Licensed
Professional