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B-2018-1006 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1006 10238 E ESTATES DR CUPERTINO,CA 95014-3305(369 07 027) RESIDENTIAL HEATING AND AIR CONDITIONING INC CAMPBELL,CA 95008 OWNER'S NAME: DATE ISSUED:06/13/2018 OWNER'S PHONE: PBONE NO;(408)377-4073 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class R C20 -lc.#70554 Contractor RESIDENTIAL HEATING AND AIR CONDITIONING INC Date —X BLDG_ELECT_PLUMB 04/30/2019 X MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am Bcensed 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;REPLACE A/C UNIT- SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Seaton 3700 of the Labor Code,for the „�rprrormance of the work for which this permit is issued. Section 3700 of the Labor Code,for the perf curruce of the work for which this Sq.Ft Floor Area: Valuation:$14000,00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: Information is correct.I agree to comply with all city and county ordinances 369 07 027 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 regulations per the Cupertino Municipal Code,Section 9.18. — - �"— Date 06/13/2018 Date:06/13/2018 OWNER-BUILDER DECLARATION RE-ROOFS: I 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 a roof is following two reasons: installed without fust obtaining an inspection,I agree to remove all new materials for 1. I,m 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(See.7044,Business&Professions Code) Signature o£ApplicanC z. I,as owner of the property,am exclusively contracting with licensed Data:06/13/2018 contractors to construct the project(Sec.7044,Business&Professions 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 of the work for which this permit is issued. I have read the hazardous materials requirements under 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 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 Code,Section 25532(a)should I store or handle hazardous I I certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous shall not employ any person N any manner so as to become subject[o the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California.If,after making this certificate of the Health&Safety Code,,Sections -io2^55505,X25555333,and 25534. exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Data:06/13/2018 .APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there Is a construction lending 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 Signature Date 0 6/1 312 01 8 Professional