B-2018-0860 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0860
7497 ROLLINGDELL DR CUPERTINO,CA 95014-5812(359 32 013) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: DATE ISSUED;05/18/2018
OWNER'S PHONE: PHONE NO:(408)283-9536
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#742M9
Contractor R SAMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG ELECT_PLUMB
Date 10/31/2019 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that 1 am licensed under the provisions of Chapter 9(con
nenelog
with Section 7000)of Dlelsion 3 of the Business&Professions Code andthat my JOB DESCRIPTION:
license is in full force and effect, REPLACE DUCTLESS HEAT PUMP
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the
\ rfonmance 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 the Labor Code,for the performance of the work for which[his Sq.Ft Floor Area: Valuation;$13388.00
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 359 32 013
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 Munich at C ,Section 9.18.
Issued by:Jasmine Archbold
Signalu Date 05/18/2018 Date:05/18/2018
OWNER-BUILDER DECLARATION RP%ROOFS:
I hereby affirm that I am exempt Train the Contractor's License Law for one or the All roofs shall be inspected to to any roofing material being installed.Ito.of is
following two reasons: installed without first obtaining an nspection,I agree to remove all new materials for
t. I,as owner of the property,or my employees with wages as their sole inspection.
eompensmom,will do the work,and the structure is not intended or offered for
We(Sec.7044,Business&J7rofessions Cade) Signature of Applicant:
z I,as owner of the property,am exclusively contracting with licensed Dale:05/18/2018
contractors to construct the project(Sec.7044,Business&Professions Code).
1 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 Cortilicate of Conscut to self-insure for Worker's
Compensation,asprovided for by Section 3700 of the Labor Cade,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 25534.1 wW
Section 3700 of the Labor Code,for the performance of the work for which thismaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued, Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
a. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which amB hazardous
shall not employ in an maouer so as to become subject to the air contaminants as deflaed by the Bay Area At,Quality Management District 1
p y any person y J will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California.If,aftei making this certificate of the Health&Safety Code,Sections 25505,25533,and 2 ,
exemption,f become subject to the Worker's Compensation provisions of the
Labor Code,Joust forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:05/18/2018 -
APPLI('ANT CERTIFICATION CONST
I certify that I have read this application and state that the above information is hereby affirm that there is a construction Iending 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