B-2018-0835 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0835
1110 HUNTERSTON PL CUPERTINO,CA 95014-5069(362 22 031) 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 C20 Lic.4768871
Contractor RANDO AAA HVAC INC Dale 09/30/2019 X BLDG—ELECT_PLUMB
1 herebyaffirm that I am licensed under the provisions of Charter 9 X MECH X RESIDENTIAL_COMMERCIAL
p I (commencing
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"CONDENSER
I hereby affirm under penalty of perjury one of the following two declarations: (SAME LOCATION)
h. I have and will maintain a certificate of consent to self-inswe for Won kei'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. 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 Jul which this _
permit is issued. Sq.Bt]Floor Area: Valuation:$11462.00
APPLICANT CERTITTCATION
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 362 22 031
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 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.
05-15-2018 Issued by:Kim Dunbar
Date:05/15/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt front the Contractor's License Law to,-one of'the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If.roof is
1. 1,as owner of the property,or my employees with wages n their sole installed without first obtaining an inspection,I agree to mumve all new materials for
compensation,will do the work,and the structure is not intended or offered£or inspection.
sale 1-1-1044,Business&Professions Code)
2. I,us
-of the property,am exclusively contracting with licensed Signora. fApplicant:
contractors to construct the project(Sae,7044,Business&Professions Code). Date:05-15-2018
1 hereby affirm under penalty ofperjury one of the following three declarations: ALL ROOF COVEl2INGS'I'O BE CLASS"A"OR BETTER
1. 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,lot the
performance ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z 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 Ito work Por which this California Health&Safety Codc,Sections 25505,25533,and 25534.I will
permit is issued maintain con plitance with the Cupertino Municipal Code,Chapter'1.12 and the s. 1 certify that in dee performance of the work for which anis penuit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material.Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air cootuninants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws o£Califernia.If,after making this certificate of will maintain compliance with the Cupertino Municipal Coda,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C d Sections 25505,2553,and 25534.
Labor Code,l must forthwith comply with such provisions or tits permit shall (/
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 05-15-2018
Professional