B-2018-0834 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:13-2018-0834
10396 ANSON AVE CUPERTINO,CA 95014-1352(326 41 054) 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 CC-2-0 Lic.#=8
Contractor RANDO AAA HVAC INC Date 0913012019 X BLDG ELECT_PLUMB
I hereby affirm that[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 fall force rind effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);REPLACE CONDENSER
I hereby affirm under penalty of perjury one of the following two declarations: (SAME LOCATION)
t. 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,for the
performance of the work for which this permit is issued,
z. 1 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 this
permit is issued. Sq.Ft Floor Area: Valuation:$9100.00
APPLICANTCERTIFICATION
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: Ovenpancy Type:
and slate laws relating to building construction,and hereby authorize 32641 054
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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source
Signatur GDate 05-05-2018 Issued by:Kim Dunbar
Date:05/15/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law to,-one of the RE-ROOFS:
Following five reasmrs: All roofs shall be inspected prior to any roofing material being installed.If e roof is
r. I,as owner of the property,or my employees with wages as their sole installed without fist obtaining at,inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for Inspection.
sale(&c.7044,Business&Professions Code)
2. I,as owner of The property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:05-05-2018
1 hereby affirm under penalty of perjury one of the following three dochuotfoas: 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
It.fat mance of ate work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 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 thisCalifornia 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
a. I certify that in the performance of the work for which this permit is issued,I Ilealth&Safety Code,Section 255321 should 1 store or handle hazardous
shall not employ portion in on to become subject to the material.Additionally,should l use equipment or devices which emit hazardous
p y any pe y manner so as 1 air conhaminnnts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califoruia. If,after making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of thethe Health&Safely
correct*!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.
Signature Data 05-05-2018 Licensed
Professional