B-2018-0837 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-0837
1185 CRESTLINE DR CUPERTINO,CA 95014-5034(362 25 004) RANDO AAA HVAC
INC
SAN JOSE,CA 95125
OWNER'S NAME: DATE ISSUED:05/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class QM Lic.#Z68871
Contractor RANDOAAA HVAC INC Dale 09/30/201.9 X BLDG_ELECT_PLUMB
I hereb affirm that 1 am licensed render the i—bions of Cha tar 9 X MECH X RESIDENTIAL_COMMERCIAL
y a p p (commencing
with Section 7000)of Division 3 critic Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
REPLACE CONDENSER(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two drdermians:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued.
1 have and will maintain Worker's Compensation Insur nce,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this
_--_,permit is issued. Sq.Ft Flaor Area: Valuation:$6161.00
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'lype:
and stale laws relating to building construction,and hereby authorize 362 25 004
representatives of this city to enter upon the above mentioned property for
inspection purposes.(WO)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,casts,and expenses which PERMIT EXPIRES IF WORI{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 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 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
I hereby affirm that I am exempt lYom the Court actor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,asownor rthe property,or my employees with wages as than sole installed without first obtaining at,inspection,I agree to remove all new materials for
compensation,will(lo the work,and the structure is not intended or offered for inspection.
sale(Scc.7044,Business&Professions Code)
z. 1,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:05-15-2018
1 hereby affirm under penalty of perjury one of the following Hit-declarations: ALL ROOF COVERINGS 1'O 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
z. I have and will maintain Worker's Compensation Insurance,as provided far by I have read the hmzm-dous matin lots requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Swoons 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store at-handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bey Area Air Quality Management District I
Worker's Compensation laws of California.If,afler making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compeuaatiou provisions of the the health&Safety
`
APPLICANT CERTIFICA'T'ION Date:05-15-2018
I certify that I have read this application and Slate that the above information is CONSTRUCTION LENDING AGENCY
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 ARCIII'I'ECT S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05-15-2018 Professional