B-2018-1016 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-1016
19731 WHEATON DR CUPERTINO,CA 95014-2459(316 28 029) T F F HEATING AND
AIR CONDITIONING
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:06/14/2018
OWNER'S PHONE: PHONE NO:(408)500-9245
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WC-20 Lic.#22350
Contractor T F F HEATING AND AIR CONDITIONING Dale 06/30/2020 X BLDG ELECT—PLUMB
I 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:
NEW AC UNIT(SIDE YARD)
1 hereby affirm under penalty of perjury one o£the following two declarations:
r. I have and will maintain a certificate of consent to self-insure for Worker's
mpensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
have end will maininto Worker's Compensation Insurance,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:$6150.00
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: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 316 28 029
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 Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. `1yITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.1 B. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 06-14-2018 Issued by:Kim Dunbar
Date:06/14/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF.ROOFS
following two reasons: All roofs shell be inspected prior to any roofing material being installed.Us 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
ompensution,will do the work,and the structure is not intended or offered for inspection.
sale(San 7044,Business&Professions Code)
z I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:06-14-2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
3. 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 Cade,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
x. 1 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,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
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle h xurch is
shall not employ person in an Hoer so as to become subject[o the material.Additionally,should I use equipment an devices which emit hazardous
p yany pe y ma 1 air contaminants as defined by the Bay Area Air Quality Mnnagement District I
Worker's Compensation laws ofCalifernia.If,after making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sultans 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06-14-2018
certify that I have read this application and state that the above information is CONS'fI2UC' ON LENDING AGE CY
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.)
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 ARCHI'1'I':C'I"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 06-14-2018 Licensed
Professional